Provider Demographics
NPI:1407267016
Name:JEMISON, BRIDGET (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:JEMISON
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W PLYMOUTH ST
Mailing Address - Street 2:#7
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-3727
Mailing Address - Country:US
Mailing Address - Phone:213-440-4355
Mailing Address - Fax:
Practice Address - Street 1:803 FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-2300
Practice Address - Country:US
Practice Address - Phone:310-803-0863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51360363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant