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General NPI Number Information
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NPI Number | 1750930129
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Entity Type | Individual
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Provider Name | JESSICA LA
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Gender | Female
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Dates
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Enumeration Date | 09/09/2019
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Last Update Date | 01/27/2020
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Provider Practice Location Address
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Address Line | 9080 COLIMA RD
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City | WHITTIER
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State | CA
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Zip | 90605-1600
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Country | US
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Telephone | 562-945-3561
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Fax |
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Provider Business Mailing Address
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Address Line | 202 S DEL MAR AVE APT B
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City | SAN GABRIEL
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State | CA
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Zip | 91776-1348
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Country | US
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Telephone | 626-283-7318
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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 |
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License Number State |
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