Healthcare Provider Details

I. General information

NPI: 1699071571
Provider Name (Legal Business Name): JANAE D FLOYD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANAE VICKERS

II. Dates (important events)

Enumeration Date: 02/09/2011
Last Update Date: 11/20/2023
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 W 58TH ST
LOS ANGELES CA
90037-3632
US

IV. Provider business mailing address

9014 S 4TH AVE
INGLEWOOD CA
90305-2816
US

V. Phone/Fax

Practice location:
  • Phone: 323-514-1600
  • Fax:
Mailing address:
  • Phone: 323-253-0288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21315
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA21315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: