Provider Demographics
NPI:1053375766
Name:THRUSH, JERRY HAPPY (MD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:HAPPY
Last Name:THRUSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4231 BALBOA AVE # 302
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5504
Mailing Address - Country:US
Mailing Address - Phone:949-439-0455
Mailing Address - Fax:619-292-0584
Practice Address - Street 1:2204 GARNET AVE STE 209C
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3771
Practice Address - Country:US
Practice Address - Phone:949-439-0455
Practice Address - Fax:619-292-0584
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66280207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G662800Medicaid
CA00G662800Medicaid