Provider Information for 1770952103
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
JAMIE KIRK
Sex: Female
NPI: 1770952103
Last Updated: 2022-12-12
Certification Date: 2022-12-12
Certification Date: 2022-12-12
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1770952103 | ||||||||||||
| Enumeration Date | 2015-09-16 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 2208 HANFRED LN # 101-199 TUCKER, GA 30084-4810 United States Phone: 951-258-5907 | Fax: | ||||||||||||
| Primary Practice Address | 1245 S LA BREA AVE STE 197 INGLEWOOD, CA 90301-3821 United States Phone: 951-258-5907 | Fax: | ||||||||||||
| Secondary Practice Address(es) | |||||||||||||
| Health Information Exchange |
| ||||||||||||
| Other Identifiers |
| ||||||||||||
| Taxonomy |
|