Individual
JANE DASCALOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1245 16TH ST STE 100, SANTA MONICA, CA 90404-1255
(310) 301-6800
(310) 794-9035
Mailing address
5767 W CENTURY BLVD, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A88728
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A887280
BLUE SHIELD
CA
05
—
00A887280
—
CA
05
—
1710159447
—
CA
Enumeration date
04/02/2008
Last updated
12/11/2019
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