Provider Demographics
NPI:1154487569
Name:LINERT, JAYANTHI J (PA)
Entity Type:Individual
Prefix:MRS
First Name:JAYANTHI
Middle Name:J
Last Name:LINERT
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 1:1165 ALICANTE DR
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-4303
Mailing Address - Country:US
Mailing Address - Phone:650-359-7311
Mailing Address - Fax:
Practice Address - Street 1:7248 S LAND PARK DR # 2065
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3660
Practice Address - Country:US
Practice Address - Phone:916-392-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15298363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA71890Medicare UPIN