Provider Demographics
NPI:1306192687
Name:COOMANSINGH, JESSEL REUEN (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSEL
Middle Name:REUEN
Last Name:COOMANSINGH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6721 W CAMERON DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-8765
Mailing Address - Country:US
Mailing Address - Phone:816-520-1906
Mailing Address - Fax:
Practice Address - Street 1:10249 W THUNDERBIRD BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3113
Practice Address - Country:US
Practice Address - Phone:623-889-7285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5336363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant