Provider Demographics
NPI:1659810497
Name:SWANSON, STEVEN (PA-C)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:SWANSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:
Other - Last Name:JAKLIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10790 RANCHO BERNARDO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:858-554-7993
Mailing Address - Fax:858-554-6321
Practice Address - Street 1:10710 N TORREY PINES RD
Practice Address - Street 2:MAIL DROP MS 116
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1027
Practice Address - Country:US
Practice Address - Phone:858-554-7993
Practice Address - Fax:858-554-6321
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56728363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant