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NPI Code Detail

MEDICARE: JESSICA JONELL LAVOISE PA-C

MEDICARE: JESSICA JONELL LAVOISE PA-C
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
1363AS0400XSurgical Physician Assistant65726CA

General Provider Information

NPI Number : 1811774276
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA JONELL LAVOISE PA-C
Provider Business Mailing Address
First Line : PO BOX 50938
Second Line :
City : LOS ANGELES
State : CA
Zip : 90074-0938
Country : US
Telephone Number : 626-457-6601
Fax Number :
Provider Business Practice Location Address
First Line : 1812 VERDUGO BLVD
Second Line :
City : GLENDALE
State : CA
Zip : 91208-1407
Country : US
Telephone Number : 818-790-7100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2023
Last Update Date : 02/06/2026

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