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

Justin Blackmon

Individual provider Physician Assistant · NPI 1699182832

Justin Blackmon is a Physician Assistant in LA Jolla, California. Qualified in 2014, 12 years ago. Practices with La Jolla Observation Medicine, a 24-clinician group and accepts Medicare assignment. Licensed in California, District of Columbia and Illinois.

Years since qualifying
12
Licensed in
CA, DC, IL
In the registry since
2014
Specialties on file
3
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Practice location Address checks out

9888 Genesee Ave
LA Jolla, CA 92037-1205
Phone: (858) 626-4123
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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 53958 (CA)
Physician Assistant Taxonomy 363A00000X · Licence PA031058 (DC)
Medical Physician Assistant Taxonomy 363AM0700X · Licence 085.005596 (IL)

Record details

NPI number1699182832
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJuly 21, 2014
Last updated in NPPESOctober 31, 2016
Mailing address4818 Glendarion Dr, Durham, NC 27713-8025

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice La Jolla Observation Medicine — 24 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in LA Jolla