Provider Demographics
NPI:1114683422
Name:GENDEL, JAMAICA ALICIA (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMAICA
Middle Name:ALICIA
Last Name:GENDEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 S DOHENY DR APT 305
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-2941
Mailing Address - Country:US
Mailing Address - Phone:408-439-3282
Mailing Address - Fax:
Practice Address - Street 1:201 S LASKY DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3610
Practice Address - Country:US
Practice Address - Phone:310-424-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant