MEDICARE: NICOLE JEAN

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	104100000X	Social Worker	66080	CA

General Provider Information

NPI Number	:	1497255616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE JEAN

Provider Business Mailing Address
First Line	:	933 N LA BREA AVE STE 100
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90038-2337
Country	:	US
Telephone Number	:	323-499-2650
Fax Number	:

Provider Business Practice Location Address
First Line	:	933 N LA BREA AVE STE 100
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90038-2337
Country	:	US
Telephone Number	:	323-499-2650
Fax Number	:

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

Provider Enumeration Date	:	02/14/2018
Last Update Date	:	02/14/2018

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Directions to “ NICOLE JEAN ” Practice Location

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