Provider Demographics
NPI:1033690961
Name:COLLINS, JACOB DANIEL (PA-C)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:DANIEL
Last Name:COLLINS
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5901 W OLYMPIC BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4669
Mailing Address - Country:US
Mailing Address - Phone:310-651-9017
Mailing Address - Fax:
Practice Address - Street 1:5901 W OLYMPIC BLVD STE 401
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4669
Practice Address - Country:US
Practice Address - Phone:310-651-9017
Practice Address - Fax:323-954-1081
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2022-11-17
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant