Provider Demographics
NPI:1073561072
Name:GARNER, JARDENA (PA)
Entity Type:Individual
Prefix:
First Name:JARDENA
Middle Name:
Last Name:GARNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W ARBOR DR
Mailing Address - Street 2:UCSD MEDICAL CENTER - DEPARTMENT OF ORTHOPEDICS
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-9000
Mailing Address - Country:US
Mailing Address - Phone:619-543-2539
Mailing Address - Fax:619-543-2540
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:UCSD MEDICAL CENTER - DEPARTMENT OF ORTHOPEDICS
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9000
Practice Address - Country:US
Practice Address - Phone:619-543-2539
Practice Address - Fax:619-543-2540
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008989363A00000X
CAPA21422363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02331244Medicaid
NY02331244Medicaid
NY5F50123051Medicare PIN
P72460Medicare UPIN
NY5F5011Medicare PIN
NYA400008050Medicare PIN