Provider Demographics
NPI:1417130147
Name:AUFHAUSER, JENNIE (PA)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:AUFHAUSER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 SANTA MONICA BLVD STE 480W
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2121
Mailing Address - Country:US
Mailing Address - Phone:310-954-9501
Mailing Address - Fax:310-954-9502
Practice Address - Street 1:2001 SANTA MONICA BLVD STE 480W
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2121
Practice Address - Country:US
Practice Address - Phone:310-954-9501
Practice Address - Fax:310-954-9502
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19475207N00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA19475OtherLICENSE NUMBER