Provider Demographics
NPI:1275569113
Name:TODD, GERALD ANDREW (PA)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:ANDREW
Last Name:TODD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 N PRAIRIE AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4509
Mailing Address - Country:US
Mailing Address - Phone:323-944-0949
Mailing Address - Fax:323-782-0388
Practice Address - Street 1:301 N PRAIRIE AVE STE 230
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4509
Practice Address - Country:US
Practice Address - Phone:323-944-0949
Practice Address - Fax:323-782-0388
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13916363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPA13916AMedicare ID - Type UnspecifiedPPIN