Provider Demographics
NPI:1629413612
Name:JEHA, PAULA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:
Last Name:JEHA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 696
Mailing Address - Street 2:
Mailing Address - City:DIABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94528-0696
Mailing Address - Country:US
Mailing Address - Phone:925-980-3768
Mailing Address - Fax:
Practice Address - Street 1:1981 N BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3852
Practice Address - Country:US
Practice Address - Phone:925-287-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA369687163W00000X
CA7431363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse