MEDICARE: JEANNE MARIE ABBOTT PRINZIVALLI

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	106H00000X	Marriage & Family Therapist	52833	CA
2	225700000X	Massage Therapist	165	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7667	OTHER	CA	MEDI-CAL
2	7184	OTHER	CA	MEDI-CAL
3	7368	OTHER	CA	MEDI-CAL
4	7708	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1366749103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNE MARIE ABBOTT PRINZIVALLI

Provider Business Mailing Address
First Line	:	10008 NATIONAL BLVD # 236
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-3809
Country	:	US
Telephone Number	:	310-806-5386
Fax Number	:	323-879-3899

Provider Business Practice Location Address
First Line	:	10642 SANTA MONICA BLVD APT 209
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-4850
Country	:	US
Telephone Number	:	323-879-7809
Fax Number	:	323-879-3899

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

Provider Enumeration Date	:	02/14/2011
Last Update Date	:	05/26/2026

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