Individual
JELISSA ASHLEY MOOYIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1250 16TH ST, SANTA MONICA, CA 90404-1249
(310) 319-4698
(310) 319-4908
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
A180627
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NA
—
GA
Enumeration date
05/01/2019
Last updated
04/22/2024
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