1275598591 NPI number — JILL M ATTIA C.R.N.P.

Table of content: JILL M ATTIA C.R.N.P. (NPI 1275598591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275598591 NPI number — JILL M ATTIA C.R.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ATTIA
Provider First Name:
JILL
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
C.R.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275598591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 232410
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92193-2410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-249-6748
Provider Business Mailing Address Fax Number:
619-543-3183

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3855 HEALTH SCIENCES DR
Provider Second Line Business Practice Location Address:
UCSD MOORES CANCER CENTER
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92093-1503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-952-5895
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  R149302 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 407889600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".