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General NPI Number Information
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NPI Number | 1831846138
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Entity Type | Individual
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Provider Name | ENEDA SHENGJERGJI
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Gender | Female
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Dates
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Enumeration Date | 03/07/2022
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 514 PROSPECT AVE
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City | REDONDO BEACH
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State | CA
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Zip | 90277
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Country | US
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Telephone | 310-896-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 514 N PROSPECT AVE
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City | REDONDO BEACH
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State | CA
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Zip | 90277-3036
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Country | US
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Telephone | 773-957-9676
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 26638
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056.009647
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License Number State | IL
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