MR. ANGEL PEMAYUN ANAK-AGUNG-GEDE (NPI# 1356675037) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356675037 |
| Entity Type | Individual |
| Full Name | MR. ANGEL PEMAYUN ANAK-AGUNG-GEDE |
| Credential | PA-C |
| Practice Address |
5717 Pacific Center Blvd Ste 200 San Diego CA 92121-4250 |
| Practice Telephone | 8588591188 |
| Practice Fax Number | 8444048924 |
| Mailing Telephone | 8588591188 |
| Mailing Fax Number | 8444048924 |
| Enumeration Date | 2009-09-28 |
| Last Update Date | 2019-05-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA19498 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | STATE LICENSE | 19498 | 01 |
| Street Address |
5717 PACIFIC CENTER BLVD STE 200 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92121-4250 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629000104 | Laurie Eastwood Raher | Nurse Practitioner | 5717 Pacific Center Blvd Ste 200, San Diego, CA 92121-4250 | 2006-07-07 |
| 1053881235 | Ann Crane Durham | Nurse Practitioner | 5717 Pacific Center Blvd Ste 200, San Diego, CA 92121-4250 | 2018-11-29 |
| 1356852206 | Maria Cecilia Cruz Jamito | Nurse Practitioner | 5717 Pacific Center Blvd Ste 200, San Diego, CA 92121-4250 | 2017-10-18 |
| 1083139190 | Emily Ann Lee | Nurse Practitioner | 5717 Pacific Center Blvd Ste 200, San Diego, CA 92121-4250 | 2017-08-09 |
| 1578087029 | Jessica Daniela Welch | Nurse Practitioner | 5717 Pacific Center Blvd Ste 200, San Diego, CA 92121 | 2017-07-26 |
| 1912420142 | Samantha Corinne Lipka Hawley | Physician Assistant | 5717 Pacific Center Blvd Ste 200, San Diego, CA 92121-4250 | 2017-07-19 |
| 1689101362 | Allysen Kelly | Nurse Practitioner | 5717 Pacific Center Blvd Ste 200, San Diego, CA 92121-4250 | 2017-05-12 |
| 1992231096 | Julie Whitacre | Registered Nurse | 5717 Pacific Center Blvd Ste 200, San Diego, CA 92121 | 2017-05-10 |
| 1568997336 | Katherine Anne Cupka | Nurse Practitioner | 5717 Pacific Center Blvd Ste 200, San Diego, CA 92121-4250 | 2017-04-28 |
| 1396277489 | Kristin Leigh Beseke | Nurse Practitioner | 5717 Pacific Center Blvd Ste 200, San Diego, CA 92121 | 2017-03-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225644917 | Anna Hand | Physical Therapist | 5945 Pacific Center Blvd Bldg #510, San Diego, CA 92121 | 2020-09-18 |
| 1972138030 | Lamarr Joyner | Licensed Vocational Nurse | 5930 Conerstone Court West, Suite 300, San Diego, CA 92121 | 2020-03-10 |
| 1396383212 | La Jolla Professional Plastic Surgery | Plastic Surgery | 4510 Executive Dr. Suite 105, San Diego, CA 92121 | 2019-12-11 |
| 1841852472 | Unmanned Systems Operations Group | Air Carrier | 4655 Executive Dr., Suite 700, San Diego, CA 92121 | 2019-07-03 |
| 1861051922 | Grace Getchell | Behavior Technician | 3978 Sorrento Valley Blvd. #100, San Diego, CA 92121 | 2019-06-11 |
| 1720643299 | Megan Jean Bathen | Behavior Technician | Cortica Behavioral Inc., 7090 Miratech Dr., San Diego, CA 92121 | 2019-05-09 |
| 1346804366 | Daniel Melita | Massage Therapist | 11689 Sorrento Valley Rd Ste Q, San Diego, CA 92121 | 2019-04-25 |
| 1831674464 | Stepahnie Becerra | Behavior Technician | 3978 Sorrento Valley Blvd Suite 100, San Diego, CA 92121 | 2018-09-28 |
| 1265915466 | Ailyn Martinez | Behavior Technician | 3978 Sorrento Valley Bldv, 100, San Diego, CA 92121 | 2018-09-13 |
| 1790265163 | Genben Lifesciences Corporation | Public Health or Welfare | 6370 Lusk Blvd Ste F205, San Diego, CA 92121 | 2018-08-15 |
| Find all providers in zip 92121 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083213706 | Courtney Kathryn Hopp | Physician Assistant | 4060 Fourth Ave Ste 209, San Diego, CA 92103-2120 | 2020-10-23 |
| 1639776503 | Nathan Tuan Dinh | Physician Assistant | 8296 Via Escalada, San Diego, CA 92129-2223 | 2020-10-05 |
| 1750988671 | Denise Aquino | Physician Assistant | 7322 Mesa College Dr Apt 7, San Diego, CA 92111-4943 | 2020-10-04 |
| 1962009183 | Courtney Krysl | Physician Assistant | 14434 Corte Lampara, San Diego, CA 92129-3818 | 2020-10-01 |
| 1497369284 | Brian Carroll | Physician Assistant | 7242 Melotte St, San Diego, CA 92119-1613 | 2020-08-31 |
| 1871104067 | Satoshi Ikeda | Physician Assistant | 16198 Paseo Del Sur, San Diego, CA 92127-6155 | 2020-08-12 |
| 1760009989 | Lili Tran | Physician Assistant | 8865 Calle Tragar, San Diego, CA 92129-2156 | 2020-07-03 |
| 1245857259 | Kendra Roberta Witt | Physician Assistant | 11396 Poblado Rd, San Diego, CA 92127-1351 | 2020-06-25 |
| 1336766344 | Brandon Scott Johnson | Physician Assistant | 1540 Oliver Ave Apt C, San Diego, CA 92109-5595 | 2020-06-25 |
| 1104441021 | Kira Ann Tellache | Physician Assistant | 4520 Executive Dr Ste 325, San Diego, CA 92121-3087 | 2020-06-16 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.