Healthcare Provider Details

I. General information

NPI: 1033343504
Provider Name (Legal Business Name): MRS. JESSICA FOSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21520 PIONEER BLVD STE 110
HAWAIIAN GARDENS CA
90716-2603
US

IV. Provider business mailing address

21520 PIONEER BLVD STE 110
HAWAIIAN GARDENS CA
90716-2603
US

V. Phone/Fax

Practice location:
  • Phone: 562-865-3644
  • Fax:
Mailing address:
  • Phone: 562-865-3644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: