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Individual

MARISSA ROBIN JENNINGS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
808 W 58TH ST, LOS ANGELES, CA 90037-3632
(323) 541-1600
Mailing address
3324 CASTLE HEIGHTS AVE APT 109, LOS ANGELES, CA 90034-2736
(704) 999-5827

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
4517
SC
363AM0700X
Medical Physician Assistant
Primary
62675
CA
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
05/31/2022
Last updated
06/21/2023
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