Wellhaven Primary Care

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

WELLHAVEN PRIMARY CARE

Practice address

5555 Reservoir Dr Ste 303
San Diego, CA 92120-5181

Phone

(619) 752-2280

NPI assigned

Jul 4, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jillion T Harris, MD

Title

Owner

Phone

(619) 752-2280

Specialties & licenses 1

Addresses

Other names 1

• Wellhaven Primary Care LLC Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1593820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593820800000",
    "number": "1306463542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5663 BALBOA AVE # 517",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921112705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 RESERVOIR DR STE 303",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921205181",
            "telephone_number": "619-752-2280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLHAVEN PRIMARY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-04",
        "last_updated": "2020-07-04",
        "certification_date": "2020-07-04",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "JILLION",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "619-752-2280",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellhaven Primary Care LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Primary Care Clinic/Center in San Diego, CA
• Providers in San Diego, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.