Provider Demographics
NPI:1730743345
Name:AUSTIN, JITLADA LAPMA (ACNPC-AG)
Entity type:Individual
Prefix:
First Name:JITLADA
Middle Name:LAPMA
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5725 W LAS POSITAS BLVD STE 100A
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-4054
Mailing Address - Country:US
Mailing Address - Phone:833-444-7622
Mailing Address - Fax:925-225-9520
Practice Address - Street 1:5725 W LAS POSITAS BLVD STE 100A
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-4054
Practice Address - Country:US
Practice Address - Phone:833-444-7622
Practice Address - Fax:925-225-9520
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011604363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner