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

Jennifer Kaori Fukasawa-Lara, PA-C

Individual provider Physician Assistant · NPI 1477093714

Jennifer Kaori Fukasawa-Lara, PA-C is a Physician Assistant in Banning, California. Qualified in 2016, 10 years ago. Practices with Carbon Health Medical Group of California PC, a 332-clinician group, accepts Medicare assignment and offers telehealth. Licensed in California.

Years since qualifying
10
Licensed in
CA
In the registry since
2017
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

600 N Highland Springs Ave
Banning, CA 92220-3046
Phone: (951) 845-1121
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA54259 (CA)

Record details

NPI number1477093714
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorYes
NPI enumeratedMarch 6, 2017
Last updated in NPPESNovember 12, 2020
Certification dateNovember 12, 2020

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Carbon Health Medical Group Of California Pc — 332 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Banning