Healthcare Provider Details

I. General information

NPI: 1962024950
Provider Name (Legal Business Name): JACQUELINE K VOLZ CTRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21732 S VERMONT AVE
TORRANCE CA
90502-2179
US

IV. Provider business mailing address

21732 S VERMONT AVE STE 210
TORRANCE CA
90502-2180
US

V. Phone/Fax

Practice location:
  • Phone: 213-663-6746
  • Fax:
Mailing address:
  • Phone: 562-858-4675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number59977
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number59977
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: