Provider Demographics
NPI:1922154707
Name:ACOBA, DOUGLAS LEA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:LEA
Last Name:ACOBA
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6272 LOLLY LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-5625
Mailing Address - Country:US
Mailing Address - Phone:619-262-1324
Mailing Address - Fax:
Practice Address - Street 1:2650 STOCKTON RD
Practice Address - Street 2:OCCUPATIONAL HEALTH UNIT
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-6000
Practice Address - Country:US
Practice Address - Phone:619-524-4921
Practice Address - Fax:619-524-6404
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA11667363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical