Provider Information for 1902353964
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JESHURUN JOSEPH LCSW
Sex: Male
NPI: 1902353964
Last Updated: 2022-10-13
Certification Date: 2022-10-13
Certification Date: 2022-10-13
Details
Name | Value | ||||||||||||||||
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NPI | 1902353964 | ||||||||||||||||
Enumeration Date | 2016-09-07 | ||||||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||||||
Sole Proprietor | NO | ||||||||||||||||
Status | Active | ||||||||||||||||
Mailing Address | 11601 S WESTERN AVE LOS ANGELES, CA 90047-5006 United States Phone: 323-242-5000 | Fax: | ||||||||||||||||
Primary Practice Address | 11601 S WESTERN AVE LOS ANGELES, CA 90047-5006 United States Phone: 323-242-5000 | Fax: | ||||||||||||||||
Secondary Practice Address(es) | 2046 ALLEN AVE RM 100 8019 COMPTON AVE 3031 S VERMONT AVE 5054 S VERMONT AVE | ||||||||||||||||
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