Provider Demographics
NPI:1548334584
Name:AO, JOVILIA V (RN, PA)
Entity type:Individual
Prefix:MISS
First Name:JOVILIA
Middle Name:V
Last Name:AO
Suffix:
Gender:F
Credentials:RN, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2309 NORIEGA ST # 102
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-4239
Mailing Address - Country:US
Mailing Address - Phone:415-203-9383
Mailing Address - Fax:
Practice Address - Street 1:729 FILBERT ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-2760
Practice Address - Country:US
Practice Address - Phone:628-754-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA55239363AM0700X
CA467252163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S88218Medicare UPIN