Healthcare Provider Details

I. General information

NPI: 1326094582
Provider Name (Legal Business Name): JACQUELINE D ADLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7325 MEDICAL CENTER DR STE 300
WEST HILLS CA
91307-4117
US

IV. Provider business mailing address

2118 WILSHIRE BLVD # 894
SANTA MONICA CA
90403-5704
US

V. Phone/Fax

Practice location:
  • Phone: 818-595-3580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number7081A
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number7081A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: