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General NPI Number Information
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NPI Number | 1043889470
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Entity Type | Individual
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Provider Name | JAYLA FLAUM PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/21/2021
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 987 PARALLEL DR STE C
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City | LAKEPORT
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State | CA
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Zip | 95453-5708
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Country | US
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Telephone | 707-262-5088
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Fax |
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Provider Business Mailing Address
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Address Line | 104 BROWN DR
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City | MACON
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State | GA
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Zip | 31220-6754
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Country | US
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Telephone | 239-272-7589
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-11360
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 64913
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License Number State | CA
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