MEDICARE: PHYSICIAN ASSISTANT & ASSOCIATES INC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1902622426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIAN ASSISTANT & ASSOCIATES INC

Provider Business Mailing Address
First Line	:	11620 WILSHIRE BLVD STE 600
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1776
Country	:	US
Telephone Number	:	909-742-5329
Fax Number	:	844-329-4373

Provider Business Practice Location Address
First Line	:	11620 WILSHIRE BLVD STE 600
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1776
Country	:	US
Telephone Number	:	909-742-5329
Fax Number	:	844-329-4373

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JASON URTIS
Credential	:
Telephone Number	:	832-578-9847

Provider Enumeration Date	:	11/30/2024
Last Update Date	:	11/30/2024

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