Provider Demographics
NPI:1902992779
Name:JESKE, ANTONETTE ANDRES (PA)
Entity Type:Individual
Prefix:MRS
First Name:ANTONETTE
Middle Name:ANDRES
Last Name:JESKE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANTONETTE
Other - Middle Name:
Other - Last Name:ANDRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1441 CONSTITUTION BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906
Mailing Address - Country:US
Mailing Address - Phone:831-647-7611
Mailing Address - Fax:
Practice Address - Street 1:2100 POWELL STREET
Practice Address - Street 2:SUITE 900
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608
Practice Address - Country:US
Practice Address - Phone:510-350-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18565363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA185650Medicare PIN