Healthcare Provider Details

I. General information

NPI: 1679558324
Provider Name (Legal Business Name): JERRICA CHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13652 CANTARA ST DEPARTMENT OF EMERGENCY MEDICINE
PANORAMA CITY CA
91402-5423
US

IV. Provider business mailing address

13652 CANTARA ST DEPARTMENT OF EMERGENCY MEDICINE
PANORAMA CITY CA
91402-5423
US

V. Phone/Fax

Practice location:
  • Phone: 818-375-2013
  • Fax:
Mailing address:
  • Phone: 818-375-2013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number233844
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number233844
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC54289
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: