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NPI Code Detail

MEDICARE: JESSICA HERAVI PHYSICIAN ASSISTANT

MEDICARE: JESSICA HERAVI PHYSICIAN ASSISTANT
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
1363A00000XPhysician Assistant52123CA

General Provider Information

NPI Number : 1730585324
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA HERAVI PHYSICIAN ASSISTANT
Provider Business Mailing Address
First Line : 8501 WILSHIRE BLVD STE 150
Second Line :
City : BEVERLY HILLS
State : CA
Zip : 90211-3148
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8501 WILSHIRE BLVD STE 150
Second Line :
City : BEVERLY HILLS
State : CA
Zip : 90211-3148
Country : US
Telephone Number : 310-248-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2014
Last Update Date : 11/07/2017

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