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NPI Code Detail

MEDICARE: JENNIFER GRACE A DE JESUS

MEDICARE: JENNIFER GRACE A DE JESUS
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
1183500000XPharmacist63332CA

General Provider Information

NPI Number : 1932484318
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER GRACE A DE JESUS
Provider Business Mailing Address
First Line : 212 1/2 ROBINSON ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90026-6926
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1500 E GAGE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90001-1724
Country : US
Telephone Number : 323-581-0964
Fax Number : 323-581-2218
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2011
Last Update Date : 10/17/2011

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Directions to “ JENNIFER GRACE A DE JESUS ” Practice Location

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