Healthcare Provider Details

I. General information

NPI: 1114683422
Provider Name (Legal Business Name): JAMAICA ALICIA GENDEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S LASKY DR
BEVERLY HILLS CA
90212-3610
US

IV. Provider business mailing address

133 S DOHENY DR APT 305
LOS ANGELES CA
90048-2941
US

V. Phone/Fax

Practice location:
  • Phone: 310-424-2000
  • Fax:
Mailing address:
  • Phone: 408-439-3282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: