Individual
CHELSEA JORDAN LAWRANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
340 DARDANELLI LN STE 10, LOS GATOS, CA 95032
(408) 412-8100
(408) 412-8499
Mailing address
340 DARDANELLI LN STE 10, LOS GATOS, CA 95032-1418
(408) 412-8100
(831) 412-8499
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CA288052
MEDICARE PTAN
CA
01
—
PA54825
STATE LICENSE
CA
Enumeration date
05/24/2017
Last updated
07/15/2020
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