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JACK THEODORE EZZEDINE
NPI 1053137513
Physician Assistant - Medical in Alhambra, CA

Active since December 02, 2024
1000 S FREMONT AVE, ALHAMBRA, CA 91803(626) 457-4240 Get Directions Write a Review

NPPES record last updated: December 2, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jack Theodore Ezzedine NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACK THEODORE EZZEDINE (NPI 1053137513) is an individual medical provider in Alhambra, California and active in the NPI registry since December 2024.

NPPES Registry Identity

NPI1053137513
Entity TypeIndividualMale
Primary Taxonomy363AM0700X
Provider Legal NameJACK THEODORE EZZEDINE
Location Address1000 S FREMONT AVEAlhambra, CA 91803-8800
Mailing Address678 E Walnut St Unit 311Pasadena, CA 91101-2283 · (714) 713-7774
Phone(626) 457-4240
Sole ProprietorYes
Enumeration DateDecember 2, 2024
NPPES CertifiedDecember 1, 2024
✔ NPI 1053137513 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
1000 S FREMONT AVE, Alhambra, CA 91803
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KRYSTAL ESPINOZA
Physician Assistant (Medical)
1000 S FREMONT AVE
ALHAMBRA, CA 91803
Los Angeles County (626) 457-4240
THAO NGOC PHUONG PHAN
Behavior Technician
1000 S FREMONT AVE
ALHAMBRA, CA 91803
Los Angeles County (626) 759-9154
GRISELDA ELIZABETH ASCENCIO
Behavior Technician
1000 S FREMONT AVE
ALHAMBRA, CA 91803
Los Angeles County (626) 759-9154
NATALIE LOPEZ
Student in an Organized Health Care Education/Training Program
1000 S FREMONT AVE
ALHAMBRA, CA 91803
Los Angeles County (626) 457-4240
MISS ASHLEY MARTINEZ
Student in an Organized Health Care Education/Training Program
1000 S FREMONT AVE
ALHAMBRA, CA 91803
Los Angeles County (626) 457-4240
FREDERICK POSEDEL BEEMAN
Behavior Technician
1000 S FREMONT AVE
ALHAMBRA, CA 91803
Los Angeles County (907) 770-0862
HEATHER FECHNER
Physical Therapist (Pediatrics)
1000 S FREMONT AVE, UNIT 27
ALHAMBRA, CA 91803
Los Angeles County (626) 289-7472
ARIANA CALVILLO-RODRIGUEZ
Behavior Technician
1000 S FREMONT AVE
ALHAMBRA, CA 91803
Los Angeles County (626) 349-3838

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jack Ezzedine's NPI number?

The NPI number for Jack Ezzedine is 1053137513. It was assigned to this individual provider in the NPPES registry on December 2, 2024.

Where is Jack Ezzedine located?

Jack Ezzedine practices at 1000 S Fremont Ave, Alhambra, CA 91803. The listed phone number is (626) 457-4240.

What is Jack Ezzedine's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

When was this NPI record last updated?

The NPPES record for Jack Ezzedine was last updated on December 2, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.