MEDICARE: MS. JENNA ROSE BLAUSTEIN NP

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	363LA2200X	Adult Health Nurse Practitioner	317800	CA

General Provider Information

NPI Number	:	1598831547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNA ROSE BLAUSTEIN NP

Provider Business Mailing Address
First Line	:	965 COLLEGE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-3240
Country	:	US
Telephone Number	:	213-580-7344
Fax Number	:	213-580-7344

Provider Business Practice Location Address
First Line	:	965 COLLEGE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-3240
Country	:	US
Telephone Number	:	213-580-7344
Fax Number	:	213-580-7344

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/23/2007

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