Provider Demographics
NPI:1518155001
Name:SPURLOCK, LODIE NANETTE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LODIE
Middle Name:NANETTE
Last Name:SPURLOCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5638 WENLOCK ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-5035
Mailing Address - Country:US
Mailing Address - Phone:310-365-4000
Mailing Address - Fax:323-295-0595
Practice Address - Street 1:7301 STATE ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5823
Practice Address - Country:US
Practice Address - Phone:323-581-5120
Practice Address - Fax:323-581-5148
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14458363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical