Healthcare Provider Details

I. General information

NPI: 1699532127
Provider Name (Legal Business Name): JIVA MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4236 OVERLAND AVE
CULVER CITY CA
90230-3736
US

IV. Provider business mailing address

3255 SAWTELLE BLVD APT 101
LOS ANGELES CA
90066-1608
US

V. Phone/Fax

Practice location:
  • Phone: 424-265-9943
  • Fax:
Mailing address:
  • Phone: 424-265-9943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: EKTHA AGGARWAL
Title or Position: FOUNDER
Credential:
Phone: 424-265-9943