Provider Demographics
NPI:1992772529
Name:PAXSON, JESSICA E (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:E
Last Name:PAXSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3084 CRAPE MYRTLE CIR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3821
Mailing Address - Country:US
Mailing Address - Phone:443-286-0106
Mailing Address - Fax:410-296-0257
Practice Address - Street 1:3084 CRAPE MYRTLE CIR
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-3821
Practice Address - Country:US
Practice Address - Phone:443-286-0106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00585762080A0000X
CAC139250208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM53504OtherCDS
MDBP7898022OtherDEA