Active NPI
John Donnelly, PA-C
- Physician Assistant
- Carlsbad, CA
National Provider Identifier
1508548314
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA63117
- Practice address
- 2333 State St Ste 200
Carlsbad, CA 92008-1691 - Phone
- (858) 252-9202
- NPI assigned
- Aug 1, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA63117 | CA | Primary |
Addresses
Primary practice location
2333 State St Ste 200
Carlsbad, CA 92008-1691
Mailing address
2333 State St Ste 200
Carlsbad, CA 92008-1691
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA63117 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690848000000",
"number": "1508548314",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2333 STATE ST STE 200",
"city": "CARLSBAD",
"state": "CA",
"postal_code": "920081691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2333 STATE ST STE 200",
"city": "CARLSBAD",
"state": "CA",
"postal_code": "920081691",
"telephone_number": "858-252-9202"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DONNELLY",
"first_name": "JOHN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-08-01",
"last_updated": "2023-08-01",
"certification_date": "2023-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA63117",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Carlsbad, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.