1255394789 NPI number — JILL MARIE MEYER MD

Table of content: JILL MARIE MEYER MD (NPI 1255394789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255394789 NPI number — JILL MARIE MEYER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEYER
Provider First Name:
JILL
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1255394789
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4225 EXECUTIVE SQ STE 450
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA JOLLA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92037-8411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-810-0000
Provider Business Mailing Address Fax Number:
858-268-1911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
752 MEDICAL CENTER CT
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91911-6658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-421-3361
Provider Business Practice Location Address Fax Number:
619-869-4378
Provider Enumeration Date:
04/07/2006

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: 207RN0300X , with the licence number:  A95882 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: BK987Z . This is a "SO. CALIFORNIA PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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