Provider Demographics
NPI:1073761862
Name:JAY, NAOMI (NP)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:JAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 DIVISADERO ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-1702
Mailing Address - Country:US
Mailing Address - Phone:415-353-7443
Mailing Address - Fax:
Practice Address - Street 1:1600 DIVISADERO ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-1702
Practice Address - Country:US
Practice Address - Phone:415-353-7443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5927363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22685ZMedicare PIN
P52560Medicare UPIN