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Individual
MS. JESSICA T. DODGE
Active
Individual
MS. JESSICA T. DODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA 16999
CA
363AS0400X
Surgical Physician Assistant
PA16999
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107953
SFGH INTERNAL USE ONLY-COMMERCIAL NUMBER
—
Enumeration date
03/23/2007
Last updated
06/18/2010
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