MEDICARE: EN ROUTE MEDICAL STAFFING LLC

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

General Provider Information

NPI Number	:	1548884216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EN ROUTE MEDICAL STAFFING LLC

Provider Business Mailing Address
First Line	:	3705 W PICO BLVD STE 1714
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-3451
Country	:	US
Telephone Number	:	310-651-4279
Fax Number	:

Provider Business Practice Location Address
First Line	:	3705 W PICO BLVD STE 1714
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-3451
Country	:	US
Telephone Number	:	310-651-4279
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JASON CALLOWAY
Credential	:
Telephone Number	:	310-651-4279

Provider Enumeration Date	:	05/29/2020
Last Update Date	:	05/29/2020

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