Provider Demographics
NPI:1205973948
Name:PICHA, JESSICA (C N M)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PICHA
Suffix:
Gender:F
Credentials:C N M
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:GERTSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:C N M
Mailing Address - Street 1:10170 SORRENTO VALLEY RD
Mailing Address - Street 2:MAIL DROP SV-5
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1604
Mailing Address - Country:US
Mailing Address - Phone:858-784-5888
Mailing Address - Fax:
Practice Address - Street 1:2918 5TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5910
Practice Address - Country:US
Practice Address - Phone:619-688-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA536836163WP1700X
CANMW1514367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WP1700XNursing Service ProvidersRegistered NursePerinatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1514OtherNURSE MIDWIFE