Individual
JACK THEODORE EZZEDINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1000 S FREMONT AVE, ALHAMBRA, CA 91803-8800
(626) 457-4240
Mailing address
678 E WALNUT ST UNIT 311, PASADENA, CA 91101-2283
(714) 713-7774
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
12/02/2024
Last updated
12/02/2024
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