Provider Demographics
NPI:1639381759
Name:ANDERSEN, JARON ROSS
Entity Type:Individual
Prefix:
First Name:JARON
Middle Name:ROSS
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 S GRAND AVE
Mailing Address - Street 2:STE 208
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3075
Mailing Address - Country:US
Mailing Address - Phone:213-765-8088
Mailing Address - Fax:
Practice Address - Street 1:1513 S GRAND AVE
Practice Address - Street 2:STE 208
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3075
Practice Address - Country:US
Practice Address - Phone:213-765-8088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106838207X00000X
CAA97202207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9559467OtherAETNA
FL1491172OtherCIGNA
FL247090OtherBC/BS
FL002305300Medicaid
FL337281OtherAVMED
FL002305300Medicaid