MEDICARE: JOVAN IGLESIAS

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
1	376G00000X	Nursing Home Administrator	198602970	CA

General Provider Information

NPI Number	:	1114681459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOVAN IGLESIAS

Provider Business Mailing Address
First Line	:	1309 E SOMERSET PL
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3724
Country	:	US
Telephone Number	:	562-773-1961
Fax Number	:

Provider Business Practice Location Address
First Line	:	1309 E SOMERSET PL
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3724
Country	:	US
Telephone Number	:	562-773-1961
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2021
Last Update Date	:	10/22/2021

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Directions to “ JOVAN IGLESIAS ” Practice Location

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