MEDICARE: JGELT CORPORATION

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	261QA0600X	Adult Day Care Clinic/Center		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609920305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JGELT CORPORATION

Provider Business Mailing Address
First Line	:	1424 30TH ST
Second Line	:	SUITE C
City	:	SAN DIEGO
State	:	CA
Zip	:	92154-3421
Country	:	US
Telephone Number	:	619-424-8181
Fax Number	:	619-424-8151

Provider Business Practice Location Address
First Line	:	1424 30TH ST
Second Line	:	SUITE C
City	:	SAN DIEGO
State	:	CA
Zip	:	92154-3421
Country	:	US
Telephone Number	:	619-424-8181
Fax Number	:	619-424-8151

Authorized Official
Title or Position	:	PRESIDENT ADMINISTRATOR
Name	:	LUBA VAISMAN
Credential	:
Telephone Number	:	619-424-8181

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	08/22/2020

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Directions to “JGELT CORPORATION ” Practice Location

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