Jack Theodore Ezzedine
Jack Theodore Ezzedine is a Medical Physician Assistant provider (Physician Assistant) practicing in Alhambra, CA, registered in the NPPES registry with NPI 1053137513 since 2024.
✓ Active NPI ✓ Valid NPI checksum Sole proprietor
| NPI | 1053137513 |
|---|---|
| Entity type | Individual (Type 1) |
| Name | Jack Theodore Ezzedine |
| Sex | Male |
| Practice address | Alhambra, CA, 91803 |
| Phone | 6264574240 |
| Enumeration date | 2024-12-02 |
| Last updated in NPPES | 2024-12-02 |
Street address withheld — NPPES sole-proprietor addresses can be home addresses. See our data policy.
Taxonomy & licenses
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 363AM0700X | Medical Physician Assistant | Primary | — | — |
Copy-ready billing details
Provider: Jack Ezzedine NPI: 1053137513 Taxonomy: 363AM0700X (Medical Physician Assistant) Address: Alhambra, CA, 91803
Other providers at this practice address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1811814965 | Angelica Soto | Individual | Behavior Technician | Alhambra, CA |
| 1932026853 | Daniela Meza Valverde | Individual | Behavior Technician | Alhambra, CA |
| 1386745065 | Janyce Johnson | Individual | Occupational Therapist | Alhambra, CA |
| 1952457376 | Gilbert Flores | Individual | Marriage & Family Therapist | Alhambra, CA |
| 1558580548 | Joseph Becerra | Individual | Community Health Worker | Alhambra, CA |
| 1881807816 | Eastern Los Angeles Regional Center | Organization | Case Management Agency | Alhambra, CA |
| 1700090834 | Los Angeles County Department of Public Health | Organization | Public Health or Welfare Agency | Alhambra, CA |
| 1134302581 | Heike Ballmaier | Individual | Psychologist | Alhambra, CA |
Verify this record
Cross-check NPI 1053137513 against the authoritative CMS record: view Jack Theodore Ezzedine on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
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Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2024-12-02.