Healthcare Provider Details

I. General information

NPI: 1679076202
Provider Name (Legal Business Name): JANET BEDOLLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2018
Last Update Date: 03/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 E WASHINGTON BLVD
PASADENA CA
91107-1448
US

IV. Provider business mailing address

PO BOX 448
WILLIAMS CA
95987-0448
US

V. Phone/Fax

Practice location:
  • Phone: 626-296-8900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC3278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: