Provider Demographics
NPI:1003109752
Name:ELSON-WOLIN, JAMIE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:ANN
Last Name:ELSON-WOLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JAMIE
Other - Middle Name:ANN
Other - Last Name:ELSON-WOLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2121 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5720
Mailing Address - Country:US
Mailing Address - Phone:310-264-0765
Mailing Address - Fax:310-829-0765
Practice Address - Street 1:2121 WILSHIRE BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5720
Practice Address - Country:US
Practice Address - Phone:310-264-0765
Practice Address - Fax:310-829-0765
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA123003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine