Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jacob Russell Suba

Individual provider Physician Assistant · NPI 1407632532

Jacob Russell Suba is a Physician Assistant in Orange, California. Qualified in 2023, 3 years ago. Practices with Spine and Sports Specialities Medical Group, a 15-clinician group and accepts Medicare assignment.

Years since qualifying
3
In the registry since
2023

Practice location Address checks out

1120 W La Veta Ave Ste 300
Orange, CA 92868-4246
Phone: (714) 598-1745
Fax: (714) 941-9539
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1407632532
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedSeptember 5, 2023
Last updated in NPPESJanuary 16, 2025
Certification dateJanuary 16, 2025
Mailing address2863 Saint Tropez Dr, Ontario, CA 91761-0398

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Spine And Sports Specialities Medical Group — 15 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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