Provider Demographics
NPI:1154888345
Name:BELL, JACQUELINE ELISE (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ELISE
Last Name:BELL
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 S FIGUEROA ST APT 212
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2506
Mailing Address - Country:US
Mailing Address - Phone:310-499-6797
Mailing Address - Fax:
Practice Address - Street 1:222 S FIGUEROA ST APT 212
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2506
Practice Address - Country:US
Practice Address - Phone:310-499-6797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6050471744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management