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General NPI Number Information
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NPI Number | 1245955707
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Entity Type | Individual
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Provider Name | JENNIFER MAI
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Gender | Female
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Dates
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Enumeration Date | 10/06/2022
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Last Update Date | 10/06/2022
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Provider Practice Location Address
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Address Line | 11460 W WASHINGTON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90066-6030
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Country | US
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Telephone | 310-337-7115
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Fax |
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Provider Business Mailing Address
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Address Line | 12101 DALE AVE SPC 92
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City | STANTON
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State | CA
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Zip | 90680-6702
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Country | US
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Telephone | 408-680-6957
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 302994
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License Number State | CA
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