MEDICARE: JENNIFER MARIEZEHL SY CNIM

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	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1164287538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARIEZEHL SY CNIM

Provider Business Mailing Address
First Line	:	PO BOX 103631
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91189-0001
Country	:	US
Telephone Number	:	213-784-7614
Fax Number	:

Provider Business Practice Location Address
First Line	:	3863 SHERWOOD PL
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91423-4607
Country	:	US
Telephone Number	:	213-784-7614
Fax Number	:

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

Provider Enumeration Date	:	02/15/2024
Last Update Date	:	02/15/2024

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