Provider Demographics
NPI:1417262908
Name:IZZARELLI, JENNIFER V (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:V
Last Name:IZZARELLI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 NORTH SEPULVEDA BOULEVARD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266
Mailing Address - Country:US
Mailing Address - Phone:310-379-2134
Mailing Address - Fax:
Practice Address - Street 1:111 NORTH SEPULVEDA BOULEVARD
Practice Address - Street 2:SUITE 210
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266
Practice Address - Country:US
Practice Address - Phone:310-379-2134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20095363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner