MEDICARE: JENIECE HALAK PA-C

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
1	363A00000X	Physician Assistant	53131	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	53131	OTHER	CA	PA BOARD OF CALIFORNIA

General Provider Information

NPI Number	:	1447616958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENIECE HALAK PA-C

Provider Business Mailing Address
First Line	:	2324 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-4002
Country	:	US
Telephone Number	:	213-383-3600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2324 W PICO BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-4002
Country	:	US
Telephone Number	:	213-383-3600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2016
Last Update Date	:	03/07/2023

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