Individual
MISS IDA JELVEH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C, MSPAS, MPH
Contact information
Practice address
28096 EDELWEISS CT, LAGUNA NIGUEL, CA 92677-7006
(949) 291-0089
Mailing address
28096 EDELWEISS CT, LAGUNA NIGUEL, CA 92677-7006
(949) 291-0089
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA55747
CA
Other
Enumeration date
07/13/2018
Last updated
07/13/2018
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