Provider Demographics
NPI:1154840551
Name:NDIKURIYO, JEAN-PIERRE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JEAN-PIERRE
Middle Name:
Last Name:NDIKURIYO
Suffix:
Gender:M
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 1:1515 7TH ST UNIT 379
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2605
Mailing Address - Country:US
Mailing Address - Phone:310-254-8274
Mailing Address - Fax:
Practice Address - Street 1:13118 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-4645
Practice Address - Country:US
Practice Address - Phone:818-255-5382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-17
Last Update Date:2017-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54896363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant