Healthcare Provider Details

I. General information

NPI: 1295061554
Provider Name (Legal Business Name): JARDINE POSADAS MARVAN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JARDINE POSADAS DIZON

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 WILSHIRE BLVD STE 300
LOS ANGELES CA
90057-3503
US

IV. Provider business mailing address

3521 GREENSWARD RD
LOS ANGELES CA
90039-2110
US

V. Phone/Fax

Practice location:
  • Phone: 213-413-2700
  • Fax:
Mailing address:
  • Phone: 323-363-9226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: