Individual
ANN VAN BOURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6655 ALVARADO RD, SAN DIEGO, CA 92120-5208
(619) 287-3270
Mailing address
13727 CONDESA DR, DEL MAR, CA 92014-3301
(760) 331-7425
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992307078
—
CA
Enumeration date
11/12/2020
Last updated
06/22/2022
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