Provider Demographics
NPI:1417222027
Name:ZELAYA, JAMI VAN DER WIELEN (PNP)
Entity type:Individual
Prefix:
First Name:JAMI
Middle Name:VAN DER WIELEN
Last Name:ZELAYA
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:JAMI
Other - Middle Name:MARIE
Other - Last Name:VANDERWIELEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PNP
Mailing Address - Street 1:3701 WILSHIRE BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2814
Mailing Address - Country:US
Mailing Address - Phone:323-361-3550
Mailing Address - Fax:
Practice Address - Street 1:673 HURON PL
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-2600
Practice Address - Country:US
Practice Address - Phone:909-525-0039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP21469207LP3000X
CA21469363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology