Provider Demographics
NPI:1841627411
Name:SHLOMO, DAPHNA (PA-C)
Entity type:Individual
Prefix:
First Name:DAPHNA
Middle Name:
Last Name:SHLOMO
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-6529
Mailing Address - Country:US
Mailing Address - Phone:619-234-2158
Mailing Address - Fax:
Practice Address - Street 1:1230 COLUMBIA ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-8502
Practice Address - Country:US
Practice Address - Phone:619-232-3500
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA23238363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant