Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A123003 | CA |
NPI | 1003109752 |
---|---|
Provider Name | Dr. Jamie Ann Elson-Wolin |
First Address | Santa Monica, CA 90403-5720 |
Second Address | Santa Monica, CA 90403-5720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2011 |
Last Update Date | 12/11/2018 |