Provider Demographics
NPI:1033540554
Name:UNRUH, JASON (PA-C)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:UNRUH
Suffix:
Gender:M
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:PO BOX 99087
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92169-1087
Mailing Address - Country:US
Mailing Address - Phone:619-861-9759
Mailing Address - Fax:619-684-3790
Practice Address - Street 1:3812 BERNICE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-2702
Practice Address - Country:US
Practice Address - Phone:619-861-9759
Practice Address - Fax:619-684-3790
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21321363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical