1629321203 NPI number — JESSICA SAYA COLLINS M.D., F.R.C.S.C.

Table of content: JESSICA SAYA COLLINS M.D., F.R.C.S.C. (NPI 1629321203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629321203 NPI number — JESSICA SAYA COLLINS M.D., F.R.C.S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLLINS
Provider First Name:
JESSICA
Provider Middle Name:
SAYA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., F.R.C.S.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLIN-DURAND
Provider Other First Name:
JESSICA
Provider Other Middle Name:
NATALIE ALEXANDRA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629321203
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5893 COPLEY DR
Provider Second Line Business Mailing Address:
4TH FLOOR PLASTIC SURGERY CLINIC
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92111-7906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-616-5001
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5893 COPLEY DR
Provider Second Line Business Practice Location Address:
4TH FLOOR PLASTIC SURGERY CLINIC
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-616-5001
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2012

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: 208200000X , with the licence number:  A 123315 , 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)