Provider Demographics
NPI:1073382495
Name:JASON UNRUH PHYSICIAN ASSISTANT INC
Entity Type:Organization
Organization Name:JASON UNRUH PHYSICIAN ASSISTANT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:CORY
Authorized Official - Last Name:UNRUH
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:619-861-9759
Mailing Address - Street 1:2710 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-1312
Mailing Address - Country:US
Mailing Address - Phone:619-663-6349
Mailing Address - Fax:619-684-3790
Practice Address - Street 1:2710 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-1312
Practice Address - Country:US
Practice Address - Phone:619-663-6349
Practice Address - Fax:619-684-3790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center