Provider Demographics
NPI:1891519385
Name:SPYROU, JOANNA MARIE (PA-C)
Entity type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:MARIE
Last Name:SPYROU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7770 REGENTS RD STE 113-580
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1937
Mailing Address - Country:US
Mailing Address - Phone:408-886-8955
Mailing Address - Fax:
Practice Address - Street 1:7770 REGENTS RD STE 113-580
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1937
Practice Address - Country:US
Practice Address - Phone:408-886-8955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA65250363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant