Healthcare Provider Details

I. General information

NPI: 1487836995
Provider Name (Legal Business Name): JESSICA ELLEN LLOYD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-1752
US

IV. Provider business mailing address

10833 LE CONTE AVE BOX 951752, 12-494 MDCC
LOS ANGELES CA
90095-1752
US

V. Phone/Fax

Practice location:
  • Phone: 818-364-3233
  • Fax:
Mailing address:
  • Phone: 310-825-9124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA103708
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: