Healthcare Provider Details

I. General information

NPI: 1023158698
Provider Name (Legal Business Name): JODA HERRAN WEATHERSBY N.P., PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 N FIGUEROA ST RM 347
LOS ANGELES CA
90012-2601
US

IV. Provider business mailing address

PO BOX 1131
ANAHEIM CA
92815-1131
US

V. Phone/Fax

Practice location:
  • Phone: 213-240-8051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN484689 NP11635
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN484689 NP11635
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License NumberRN484689 CNS1319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: