Most Relevant Information
Provider Data
| NPI Number: | 1003318981 |
| Provider Name: | JALA JEFFERSON |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/06/2018 |
| Last Updated: | 07/04/2023 |
Provider Practice Location
540 S EREMLAND DR
COVINA
CA
917233186
Practice Location Phone/Fax
| Phone: | 6269661577 |
| Fax: |
Provider Mailing Location
41521 W 11 MILE RD
NOVI
MI
483751803
Provider Mailing Phone/Fax
| Phone: | 2482990030 |
| Fax: |