Healthcare Provider Details

I. General information

NPI: 1326938135
Provider Name (Legal Business Name): JESSE O'NEAL ELECTROLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2025
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10123 HAWTHORNE BLVD
INGLEWOOD CA
90304-1513
US

IV. Provider business mailing address

579 WASHINGTON BLVD
MARINA DEL REY CA
90292-5420
US

V. Phone/Fax

Practice location:
  • Phone: 361-232-0499
  • Fax:
Mailing address:
  • Phone: 361-232-0499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberL9893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: