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NPI Code Detail

MEDICARE: JOVAN BERRY

MEDICARE:   JOVAN  BERRY
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
1106S00000XBehavior Technician010097632LA

General Provider Information

NPI Number : 1699140830
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOVAN BERRY
Provider Business Mailing Address
First Line : 21600 OXNARD ST STE 1800
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-7807
Country : US
Telephone Number : 818-345-2345
Fax Number : --
Provider Business Practice Location Address
First Line : 21600 OXNARD ST STE 1800
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-7807
Country : US
Telephone Number : 818-345-2345
Fax Number : --
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2015
Last Update Date : 08/05/2020

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Directions to “ JOVAN BERRY ” Practice Location

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