DR. JACK WASSERMAN M.D.
NPI 1306914783
Family Medicine in San Diego, CA

Q: What is Jack Wasserman's NPI number?

The NPI number for Jack Wasserman is 1306914783. It was assigned to this individual provider in the NPPES registry on December 1, 2006.

Q: What is Jack Wasserman's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Q: When was this NPI record last updated?

The NPPES record for Jack Wasserman was last updated on December 28, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since December 01, 2006

9999 MIRA MESA BLVD STE 104, SAN DIEGO, CA 92131(858) 271-6962(858) 271-5327 Get Directions Write a Review

NPPES record last updated: December 28, 2009. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Dr. Jack Wasserman M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JACK WASSERMAN M.D. (NPI 1306914783) is an individual family medicine provider in San Diego, California, licensed in California (G30311) and active in the NPI registry since December 2006.

NPPES Registry Identity

NPI1306914783

Entity TypeIndividualMale

Primary Taxonomy207Q00000X

Provider Legal NameDR. JACK WASSERMANCredential: M.D.

Location Address9999 MIRA MESA BLVD STE 104San Diego, CA 92131-1006

Mailing Address9999 Mira Mesa Blvd Ste 104San Diego, CA 92131-1006 · (858) 271-6962 · Fax (858) 271-5327

Phone(858) 271-6962

Fax(858) 271-5327

Sole ProprietorNo

Enumeration DateDecember 1, 2006

Last NPPES UpdateDecember 28, 2009

✔ NPI 1306914783 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in CA · G30311

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

9999 MIRA MESA BLVD STE 104, San Diego, CA 92131

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Other Identifiers 3

OtherG30311CA · License

Medicare UPINA44374CA

Medicare ID-Type UnspecifiedWA30311ACA

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SCRIPPS RANCH MEDICAL CLINIC

Family Medicine

9999 MIRA MESA BLVD STE 104
SAN DIEGO, CA 92131

San Diego County (858) 271-6962

DR. ADRIENNE ERTL M.D.

Family Medicine

9999 MIRA MESA BLVD STE 104
SAN DIEGO, CA 92131

San Diego County (858) 271-6962

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jack Wasserman's NPI number?

The NPI number for Jack Wasserman is 1306914783. It was assigned to this individual provider in the NPPES registry on December 1, 2006.

Where is Jack Wasserman located?

Jack Wasserman practices at 9999 Mira Mesa Blvd Ste 104, San Diego, CA 92131. The listed phone number is (858) 271-6962.

What is Jack Wasserman's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

When was this NPI record last updated?

The NPPES record for Jack Wasserman was last updated on December 28, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.