MEDICARE: MS. JESSICA DOMINIQUE SAINT-PAUL PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA17893	CA

General Provider Information

NPI Number	:	1548369119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA DOMINIQUE SAINT-PAUL PA

Provider Business Mailing Address
First Line	:	400 CORPORATE POINTE
Second Line	:	SUITE 300
City	:	CULVER CITY
State	:	CA
Zip	:	90230-7615
Country	:	US
Telephone Number	:	310-357-6214
Fax Number	:	323-969-0006

Provider Business Practice Location Address
First Line	:	8732 S SEPULVEDA BLVD FL 2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-4031
Country	:	US
Telephone Number	:	831-200-3774
Fax Number	:	323-968-0006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	12/17/2020

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