MEDICARE: JAXSEN BALL

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	174400000X	Specialist

General Provider Information

NPI Number	:	1134087588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAXSEN BALL

Provider Business Mailing Address
First Line	:	2610 INDUSTRY WAY STE A
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262-4028
Country	:	US
Telephone Number	:	310-631-8004
Fax Number	:

Provider Business Practice Location Address
First Line	:	2610 INDUSTRY WAY STE A
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262-4028
Country	:	US
Telephone Number	:	310-631-8004
Fax Number	:

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

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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Directions to “ JAXSEN BALL ” Practice Location

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