Healthcare Provider Details

I. General information

NPI: 1265760623
Provider Name (Legal Business Name): JESUS FRANCO BEDOLLA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2677 ZOE AVE 303
HUNTINGTON PARK CA
90255-4195
US

IV. Provider business mailing address

5923 MALABAR ST 13
HUNTINGTON PARK CA
90255-7148
US

V. Phone/Fax

Practice location:
  • Phone: 323-312-0640
  • Fax:
Mailing address:
  • Phone: 323-582-3705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: