Provider Demographics
NPI:1992307235
Name:WITZMANN, JESSICA RAE (PA)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:RAE
Last Name:WITZMANN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:421 N HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1131
Mailing Address - Country:US
Mailing Address - Phone:858-330-3737
Mailing Address - Fax:858-346-0376
Practice Address - Street 1:25500 RANCHO NIGUEL RD STE 100
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-7373
Practice Address - Country:US
Practice Address - Phone:949-643-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
CAPA59067363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical