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NPI Code Detail

MEDICARE: JESSICA GHERMEZI

MEDICARE: JESSICA GHERMEZI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst
2103TS0200XSchool Psychologist4402CA

General Provider Information

NPI Number : 1528607629
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA GHERMEZI
Provider Business Mailing Address
First Line : 3101 OCEAN PARK BLVD STE 100
Second Line :
City : SANTA MONICA
State : CA
Zip : 90405-3029
Country : US
Telephone Number : 310-402-1564
Fax Number :
Provider Business Practice Location Address
First Line : 3101 OCEAN PARK BLVD STE 100
Second Line :
City : SANTA MONICA
State : CA
Zip : 90405-3029
Country : US
Telephone Number : 310-402-1564
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2020
Last Update Date : 08/20/2024

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Directions to “ JESSICA GHERMEZI ” Practice Location

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