MEDICARE: MISS JAHALA OLEMA WILCOX LVN

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	164X00000X	Licensed Vocational Nurse	VN254061	CA

General Provider Information

NPI Number	:	1538759188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JAHALA OLEMA WILCOX LVN

Provider Business Mailing Address
First Line	:	6200 DE SOTO AVE APT 36202
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-0218
Country	:	US
Telephone Number	:	181-861-4677
Fax Number	:

Provider Business Practice Location Address
First Line	:	6200 DE SOTO AVE APT 36202
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-0218
Country	:	US
Telephone Number	:	181-861-4677
Fax Number	:

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

Provider Enumeration Date	:	01/18/2021
Last Update Date	:	01/18/2021

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