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General NPI Number Information
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NPI Number | 1194309237
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Entity Type | Individual
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Provider Name | JEAN-ESDRACE GERMAIN CHARLES DR.
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Gender | Male
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Dates
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Enumeration Date | 05/05/2021
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Last Update Date | 05/05/2021
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Provider Practice Location Address
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Address Line | 7715 W SUNSET BLVD FRNT
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City | LOS ANGELES
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State | CA
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Zip | 90046-3912
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Country | US
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Telephone | 818-209-8147
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Fax |
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Provider Business Mailing Address
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Address Line | 145 S GLENOAKS BLVD # 303
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City | BURBANK
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State | CA
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Zip | 91502-1315
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Country | US
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Telephone | 818-209-8147
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101200000X
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Taxonomy Name | Drama Therapist
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License Number | 00000000
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License Number State | FL
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