Provider Demographics
NPI:1356631675
Name:JANCAY, CRAIG MICHAEL (PA-C)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:MICHAEL
Last Name:JANCAY
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 1:41715 WINCHESTER ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590
Mailing Address - Country:US
Mailing Address - Phone:951-308-4451
Mailing Address - Fax:
Practice Address - Street 1:41715 WINCHESTER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4808
Practice Address - Country:US
Practice Address - Phone:951-308-4451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22252363A00000X
PAMA054835363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical