Provider Demographics
NPI:1598528879
Name:HFMLA PHYSICIAN ASSISTANT INC
Entity Type:Organization
Organization Name:HFMLA PHYSICIAN ASSISTANT INC
Other - Org Name:HOLISTIC FAMILY MEDICINE OF LOS ANGELES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER/PA-C
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:323-651-4454
Mailing Address - Street 1:6221 WILSHIRE BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5226
Mailing Address - Country:US
Mailing Address - Phone:917-449-3478
Mailing Address - Fax:
Practice Address - Street 1:6221 WILSHIRE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5226
Practice Address - Country:US
Practice Address - Phone:917-449-3478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-31
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty