Provider Demographics
NPI:1972730323
Name:LADA, JANA NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:NICOLE
Last Name:LADA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:N
Other - Last Name:BORJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2141 N HARBOR BLVD
Mailing Address - Street 2:SUITE 35000
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3827
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2141 N HARBOR BLVD
Practice Address - Street 2:SUITE 35000
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3827
Practice Address - Country:US
Practice Address - Phone:714-626-8620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20354363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant