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General NPI Number Information
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NPI Number | 1548369119
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Entity Type | Individual
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Provider Name | JESSICA DOMINIQUE SAINT-PAUL PA
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Gender | Female
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 12/17/2020
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Provider Practice Location Address
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Address Line | 8732 S SEPULVEDA BLVD FL 2
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City | LOS ANGELES
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State | CA
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Zip | 90045-4031
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Country | US
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Telephone | 831-200-3774
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Fax | 323-968-0006
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Provider Business Mailing Address
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Address Line | 400 CORPORATE POINTE SUITE 300
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City | CULVER CITY
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State | CA
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Zip | 90230-7615
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Country | US
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Telephone | 310-357-6214
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Fax | 323-969-0006
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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 | PA17893
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License Number State | CA
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