Provider Demographics
NPI:1821180480
Name:CARATAN, JILL T (PAC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:T
Last Name:CARATAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:THERESE
Other - Last Name:CARATAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAC
Mailing Address - Street 1:7708 W 83RD ST
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-7919
Mailing Address - Country:US
Mailing Address - Phone:310-621-4961
Mailing Address - Fax:
Practice Address - Street 1:1328 22ND STREET
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2091
Practice Address - Country:US
Practice Address - Phone:310-582-7089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18337363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA18337Medicaid
CAQ78327Medicare UPIN
CABE760UMedicare PIN
CAPA18337Medicaid