MEDICARE: JEAN-ESDRACE GERMAIN CHARLES DR.

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	101200000X	Drama Therapist	00000000	FL

General Provider Information

NPI Number	:	1194309237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN-ESDRACE GERMAIN CHARLES DR.

Provider Business Mailing Address
First Line	:	145 S GLENOAKS BLVD # 303
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91502-1315
Country	:	US
Telephone Number	:	818-209-8147
Fax Number	:

Provider Business Practice Location Address
First Line	:	7715 W SUNSET BLVD FRNT
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-3912
Country	:	US
Telephone Number	:	818-209-8147
Fax Number	:

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

Provider Enumeration Date	:	05/05/2021
Last Update Date	:	05/05/2021

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