Provider Demographics
NPI:1760795868
Name:SCARBOROUGH, JENNIFER LEE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEE
Last Name:SCARBOROUGH
Suffix:
Gender:F
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 1:419 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2313
Mailing Address - Country:US
Mailing Address - Phone:949-903-8689
Mailing Address - Fax:
Practice Address - Street 1:7777 EDINGER AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3601
Practice Address - Country:US
Practice Address - Phone:714-602-3500
Practice Address - Fax:714-602-3502
Is Sole Proprietor?:No
Enumeration Date:2010-07-17
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
CAPA21189363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant