Healthcare Provider Details

I. General information

NPI: 1194309237
Provider Name (Legal Business Name): JEAN-ESDRACE GERMAIN CHARLES DR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7715 W SUNSET BLVD FRNT
LOS ANGELES CA
90046-3912
US

IV. Provider business mailing address

145 S GLENOAKS BLVD # 303
BURBANK CA
91502-1315
US

V. Phone/Fax

Practice location:
  • Phone: 818-209-8147
  • Fax:
Mailing address:
  • Phone: 818-209-8147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number00000000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: