Healthcare Provider Details

I. General information

NPI: 1891982344
Provider Name (Legal Business Name): JODANA SYKES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11321 CAMARILLO ST
NORTH HOLLYWOOD CA
91602-1216
US

IV. Provider business mailing address

4155 JACKSON AVE
CULVER CITY CA
90232-3233
US

V. Phone/Fax

Practice location:
  • Phone: 818-506-4455
  • Fax: 818-506-5185
Mailing address:
  • Phone: 310-204-2237
  • Fax: 818-506-5185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: