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General NPI Number Information
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NPI Number | 1548544307
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Entity Type | Individual
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Provider Name | JESSICA LEE GOULD M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/28/2011
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 4950 W SUNSET BLVD INTERNAL MEDICINE OFFICE, 6TH FLOOR
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City | LOS ANGELES
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State | CA
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Zip | 90027-5822
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Country | US
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Telephone | 323-783-4892
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Fax | 323-783-1187
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Provider Business Mailing Address
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Address Line | 4950 W SUNSET BLVD INTERNAL MEDICINE OFFICE, 6TH FLOOR
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City | LOS ANGELES
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State | CA
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Zip | 90027-5822
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Country | US
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Telephone | 323-783-4892
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Fax | 323-783-1187
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A118447
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License Number State | CA
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