Healthcare Provider Details

I. General information

NPI: 1861234635
Provider Name (Legal Business Name): JONAI CHARLTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9021 S 2ND AVE
INGLEWOOD CA
90305-2825
US

IV. Provider business mailing address

4401CRENSHAW BLVD SUITE 215
LOS ANGELES CA
90043
US

V. Phone/Fax

Practice location:
  • Phone: 323-363-4010
  • Fax:
Mailing address:
  • Phone: 323-291-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: