Healthcare Provider Details

I. General information

NPI: 1275319287
Provider Name (Legal Business Name): JAAZIEL ELI SIGALA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 03/21/2026
Certification Date: 03/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13330 VAUGHN ST
SAN FERNANDO CA
91340-2216
US

IV. Provider business mailing address

PO BOX 54
SAN FERNANDO CA
91341-0054
US

V. Phone/Fax

Practice location:
  • Phone: 818-896-7461
  • Fax:
Mailing address:
  • Phone: 818-632-5638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number18721
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18721
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: