Provider Demographics
NPI:1376794966
Name:LIPELES, JAMIE ALAN (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:ALAN
Last Name:LIPELES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JAMIE
Other - Middle Name:ALAN
Other - Last Name:LIPELES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:13650 MARINA POINTE DR
Mailing Address - Street 2:#608
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-9285
Mailing Address - Country:US
Mailing Address - Phone:310-629-2447
Mailing Address - Fax:
Practice Address - Street 1:4560 ADMIRALTY WAY
Practice Address - Street 2:STE 105
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5423
Practice Address - Country:US
Practice Address - Phone:310-629-2447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10501207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology