Basic Information
| Provider Information | |||||||||
| NPI: | 1558704668 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | LO | ||||||||
| FirstName: | JESSIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7266 FRANKLIN AVE APT 310 | ||||||||
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| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90046 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 8700 BEVERLY BLVD | ||||||||
| Address2: | SUITE 8211 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2136373703 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2013 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | A148179 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.