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NPI Code Detail

MEDICARE: JOLENE KELLY ECCLES

MEDICARE: JOLENE KELLY ECCLES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1053438531
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOLENE KELLY ECCLES
Provider Business Mailing Address
First Line : 506 W JACKMAN ST
Second Line :
City : LANCASTER
State : CA
Zip : 93534-2531
Country : US
Telephone Number : 661-726-2850
Fax Number :
Provider Business Practice Location Address
First Line : 2677 ZOE AVE STE 304
Second Line :
City : HUNTINGTON PARK
State : CA
Zip : 90255-3699
Country : US
Telephone Number : 323-346-0960
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2007
Last Update Date : 12/07/2021

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