MEDICARE: JOLLY JOSEPH

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95035527	CA

General Provider Information

NPI Number	:	1538055173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOLLY JOSEPH

Provider Business Mailing Address
First Line	:	3316 ALABAMA ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91214-1230
Country	:	US
Telephone Number	:	818-493-8297
Fax Number	:

Provider Business Practice Location Address
First Line	:	3316 ALABAMA ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91214-1230
Country	:	US
Telephone Number	:	818-493-8297
Fax Number	:

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

Provider Enumeration Date	:	06/17/2025
Last Update Date	:	06/17/2025

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Directions to “ JOLLY JOSEPH ” Practice Location

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