Provider Demographics
NPI:1154988970
Name:FREEMAN, JAMIE (RADT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 N BEACHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-4006
Mailing Address - Country:US
Mailing Address - Phone:323-463-4266
Mailing Address - Fax:323-962-6721
Practice Address - Street 1:1919 N BEACHWOOD DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-4006
Practice Address - Country:US
Practice Address - Phone:323-463-4266
Practice Address - Fax:323-962-6721
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1324060918247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1255783635OtherMEDI-CAL