MEDICARE: RUBINA JETLEY

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	1041C0700X	Clinical Social Worker	ASW 26532	CA

General Provider Information

NPI Number	:	1245306596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUBINA JETLEY

Provider Business Mailing Address
First Line	:	11705 ALAMEDA ST
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262-4023
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11705 ALAMEDA ST
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262-4023
Country	:	US
Telephone Number	:	323-568-4678
Fax Number	:

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	08/15/2012

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Directions to “ RUBINA JETLEY ” Practice Location

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