MEDICARE: JARDINE POSADAS MARVAN N.P.

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	363LF0000X	Family Nurse Practitioner	19221	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19221	OTHER	CA	STATE BOARD

General Provider Information

NPI Number	:	1295061554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARDINE POSADAS MARVAN N.P.

Provider Business Mailing Address
First Line	:	3521 GREENSWARD RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-2110
Country	:	US
Telephone Number	:	323-363-9226
Fax Number	:

Provider Business Practice Location Address
First Line	:	2011 WILSHIRE BLVD STE 300
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3503
Country	:	US
Telephone Number	:	213-413-2700
Fax Number	:

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

Provider Enumeration Date	:	10/21/2009
Last Update Date	:	02/06/2023

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