Healthcare Provider Details

I. General information

NPI: 1679070643
Provider Name (Legal Business Name): MEENAKSHI JASUJA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

12821 BAILEY ST
GARDEN GROVE CA
92845-2315
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-2040
  • Fax:
Mailing address:
  • Phone: 562-221-4323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number741335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: