Healthcare Provider Details

I. General information

NPI: 1780118265
Provider Name (Legal Business Name): JAZ CAPITAL INVESTMENTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7966 BEVERLY BLVD STE 102
LOS ANGELES CA
90048-4511
US

IV. Provider business mailing address

7966 BEVERLY BLVD STE 102
LOS ANGELES CA
90048-4511
US

V. Phone/Fax

Practice location:
  • Phone: 323-896-9431
  • Fax:
Mailing address:
  • Phone: 323-896-9431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number190945AP
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number190945AP
License Number StateCA

VIII. Authorized Official

Name: MR. JUSTIN WELLS
Title or Position: CEO
Credential:
Phone: 323-896-9431