Provider Demographics
NPI:1972614782
Name:HAMMOND, JANE FRANCES (PA-C)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:FRANCES
Last Name:HAMMOND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:FRANCES
Other - Last Name:ROLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1421 BONNELL DR
Mailing Address - Street 2:
Mailing Address - City:TOPANGA
Mailing Address - State:CA
Mailing Address - Zip Code:90290-3902
Mailing Address - Country:US
Mailing Address - Phone:310-487-0911
Mailing Address - Fax:
Practice Address - Street 1:28240 AGOURA RD STE 201
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-2437
Practice Address - Country:US
Practice Address - Phone:747-334-2443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15509363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABCP70769FOtherCDC GRP #
CAHAP70769FOtherFAM PLAN GRP #
CAFHC70769FMedicaid
CAPA15509OtherLICENSE #
CAPA15509OtherLICENSE #
CAPA15509OtherLICENSE #
CAP54296Medicare UPIN