Provider Demographics
NPI:1760756860
Name:DR. JAMIE A. LIPELES, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DR. JAMIE A. LIPELES, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LIPELES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-629-2447
Mailing Address - Street 1:4560 ADMIRALTY WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5424
Mailing Address - Country:US
Mailing Address - Phone:310-629-2447
Mailing Address - Fax:310-306-5555
Practice Address - Street 1:11602 HAWTHORNE BLVD STE A
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2316
Practice Address - Country:US
Practice Address - Phone:310-263-1400
Practice Address - Fax:310-306-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10501207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty