Healthcare Provider Details

I. General information

NPI: 1013867357
Provider Name (Legal Business Name): JAMELINE JEWELL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S VIRGIL AVE
LOS ANGELES CA
90020-1406
US

IV. Provider business mailing address

445 N ROSSMORE AVE APT 301
LOS ANGELES CA
90004-2496
US

V. Phone/Fax

Practice location:
  • Phone: 213-674-7699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number53228
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: