Healthcare Provider Details

I. General information

NPI: 1942900212
Provider Name (Legal Business Name): JENNY ASHLEY LLAMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9808 VENICE BLVD STE 505
CULVER CITY CA
90232-6818
US

IV. Provider business mailing address

9808 VENICE BLVD STE 505
CULVER CITY CA
90232-6818
US

V. Phone/Fax

Practice location:
  • Phone: 310-945-3350
  • Fax:
Mailing address:
  • Phone: 310-945-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: