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NPI Code Detail

MEDICARE: ALEC JESSEN

MEDICARE: ALEC JESSEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician15536CA
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1043912165
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEC JESSEN
Provider Business Mailing Address
First Line : TCU BOX 297085
Second Line :
City : FORT WORTH
State : TX
Zip : 76129-0001
Country : US
Telephone Number : 817-257-6633
Fax Number :
Provider Business Practice Location Address
First Line : 2051 MARENGO ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90033-1352
Country : US
Telephone Number : 323-409-1945
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2023
Last Update Date : 06/02/2026

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Directions to “ ALEC JESSEN ” Practice Location

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