Active NPI
Mary Kreshon, PA-C
- Medical Physician Assistant
- San Diego, CA
National Provider Identifier
1114349693
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 52673
- Practice address
- 6195 Lusk Blvd Ste 250
San Diego, CA 92121-3715 - Phone
- (858) 859-1188
- NPI assigned
- Jan 17, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 001004757 | NC | |
| Surgical Physician Assistant | 363AS0400X | 0010-04757 | NC | |
| Medical Physician Assistant | 363AM0700X | 52673 | CA | Primary |
Addresses
Primary practice location
6195 Lusk Blvd Ste 250
San Diego, CA 92121-3715
Mailing address
6195 Lusk Blvd Ste 250
San Diego, CA 92121-3715
Phone (858) 859-1188
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001004757 | NC | MD | Physician Assistant |
| 52673 | CA | MD | Medical Physician Assistant |
| 0010-04757 | NC | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1389916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671408000000",
"number": "1114349693",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6195 LUSK BLVD STE 250",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921213715",
"telephone_number": "858-859-1188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6195 LUSK BLVD STE 250",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921213715",
"telephone_number": "858-859-1188"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRESHON",
"first_name": "MARY",
"name_prefix": "Ms.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-01-17",
"last_updated": "2022-12-19",
"certification_date": "2022-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "001004757",
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "NC",
"license": "0010-04757",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CA",
"license": "52673",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.