Healthcare Provider Details

I. General information

NPI: 1386132116
Provider Name (Legal Business Name): JESSICA ESSER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 S SAN VICENTE BLVD
LOS ANGELES CA
90048-4621
US

IV. Provider business mailing address

467 ARNAZ DR APT 108
LOS ANGELES CA
90048-3950
US

V. Phone/Fax

Practice location:
  • Phone: 323-782-1513
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number24355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: