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General NPI Number Information
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NPI Number | 1588391346
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Entity Type | Individual
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Provider Name | MR. JIMMY LEE GAFFENEY JR.
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Gender | Male
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Dates
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Enumeration Date | 08/02/2022
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 5318 CRENSHAW BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90043-1810
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Country | US
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Telephone | 323-293-6291
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Fax | 323-293-1091
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Provider Business Mailing Address
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Address Line | 5318 CRENSHAW BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90043-1810
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Country | US
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Telephone | 323-293-6291
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Fax | 323-293-1091
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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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | CA
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