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General NPI Number Information
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NPI Number | 1952727026
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Entity Type | Organization
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Legal Business Name | J C HENRY MD INC
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Dates
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Enumeration Date | 03/12/2014
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 503 DEVONWOOD RD
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City | ALTADENA
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State | CA
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Zip | 91001-4016
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Country | US
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Telephone | 626-398-1434
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6667
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City | ALTADENA
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State | CA
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Zip | 91003-6667
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEAN-CLAUDE HENRY
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Credential | M.D.
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Telephone | 626-398-1434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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