Provider Demographics
NPI:1962579425
Name:TOTAH, JOANN L (PA)
Entity type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:L
Last Name:TOTAH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15644 POMERADO RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2400
Mailing Address - Country:US
Mailing Address - Phone:858-592-7040
Mailing Address - Fax:
Practice Address - Street 1:15644 POMERADO RD
Practice Address - Street 2:SUITE 105
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2400
Practice Address - Country:US
Practice Address - Phone:858-592-7045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13882363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ45196Medicare UPIN
CAWPA13882AMedicare ID - Type UnspecifiedMEDICARE ID #