Healthcare Provider Details

I. General information

NPI: 1841557055
Provider Name (Legal Business Name): JOY LORRAINE WELLS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 WILSHIRE BLVD
LOS ANGELES CA
90057-3503
US

IV. Provider business mailing address

1949 253RD ST
LOMITA CA
90717-1813
US

V. Phone/Fax

Practice location:
  • Phone: 310-644-8400
  • Fax:
Mailing address:
  • Phone: 310-986-1137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 22018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: