=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689555393
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUSHUMAN ENTERIZE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2025
-----------------------------------------------------
Last Update Date | 09/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 CORPORATE POINTE STE 3006003
-----------------------------------------------------
City | CULVER CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90230-7615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-220-1612
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19141 GOLDEN VALLEY RD # 1128
-----------------------------------------------------
City | SANTA CLARITA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91387-1428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-220-1612
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | LATRICE JONES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 213-220-1612
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251V00000X
-----------------------------------------------------
Taxonomy Name | Voluntary or Charitable Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------