Provider Demographics
NPI:1073713673
Name:DHILLON, JASVEEN (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:JASVEEN
Middle Name:
Last Name:DHILLON
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 MIRA LAGO WAY
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-7426
Mailing Address - Country:US
Mailing Address - Phone:602-770-6120
Mailing Address - Fax:
Practice Address - Street 1:4561 DICKEY DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-5735
Practice Address - Country:US
Practice Address - Phone:619-328-3025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19173363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical