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NPI Code Detail

MEDICARE: JESSICA TOVE MIEDZIALKO MSW

MEDICARE:   JESSICA TOVE MIEDZIALKO  MSW
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1831484054
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA TOVE MIEDZIALKO MSW
Provider Business Mailing Address
First Line : 4125 S FIGUEROA ST
Second Line : #314
City : LOS ANGELES
State : CA
Zip : 90037-2092
Country : US
Telephone Number : 480-277-9946
Fax Number :
Provider Business Practice Location Address
First Line : 4125 S FIGUEROA ST
Second Line : #314
City : LOS ANGELES
State : CA
Zip : 90037-2092
Country : US
Telephone Number : 480-277-9946
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2011
Last Update Date : 06/15/2011

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Directions to “ JESSICA TOVE MIEDZIALKO MSW” Practice Location

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