Provider Demographics
NPI:1215117643
Name:STARK, JESSICA GAYLE IRWIN (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:GAYLE IRWIN
Last Name:STARK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:GAYLE
Other - Last Name:IRWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2340 CLAY ST, 4TH FLOOR DEPARTMENT OF TRANSPLANT
Mailing Address - Street 2:CALIFORNIA PACIFIC MEDICAL CENTER
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115
Mailing Address - Country:US
Mailing Address - Phone:415-600-1010
Mailing Address - Fax:415-600-1295
Practice Address - Street 1:2340 CLAY ST, 4TH FLOOR DEPARTMENT OF TRANSPLANT
Practice Address - Street 2:CALIFORNIA PACIFIC MEDICAL CENTER
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115
Practice Address - Country:US
Practice Address - Phone:415-600-1010
Practice Address - Fax:415-600-1295
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19216363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant