Healthcare Provider Details

I. General information

NPI: 1427968478
Provider Name (Legal Business Name): JORDAN KRYSTAL BELLAMY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23430 HAWTHORNE BLVD STE 280
TORRANCE CA
90505-4764
US

IV. Provider business mailing address

16500 VENTURA BLVD STE 414
ENCINO CA
91436-5050
US

V. Phone/Fax

Practice location:
  • Phone: 818-788-1003
  • Fax:
Mailing address:
  • Phone: 818-788-1003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number29432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: