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

Individual provider Medical Physician Assistant · NPI 1336820976

Simon Pedro Jacquez, PA is a Physician Assistant in Phoenix, Arizona. Qualified in 2016, 10 years ago. Practices with Ohana Kids and Family Kare LLC, a 3-clinician group and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
10
Licensed in
AZ
In the registry since
2023
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

6211 N 35th Ave
Phoenix, AZ 85017-1415
Phone: (602) 242-5000
Fax: (480) 605-2291
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 9856 (AZ)

Record details

NPI number1336820976
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedJuly 27, 2023
Last updated in NPPESJuly 27, 2023
Certification dateJuly 26, 2023

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 Ohana Kids And Family Kare Llc — 3 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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