Most Relevant Information
Provider Data
| NPI Number: | 1003345968 |
| Provider Name: | JOHN THOMAS DERWART |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/05/2017 |
| Last Updated: | 07/21/2022 |
Provider Practice Location
11303 WILSHIRE BLVD BLDG 116
LOS ANGELES
CA
900255069
Practice Location Phone/Fax
| Phone: | 3109144045 |
| Fax: |
Provider Mailing Location
11303 WILSHIRE BLVD BLDG 116
LOS ANGELES
CA
900255069
Provider Mailing Phone/Fax
| Phone: | 3109144045 |
| Fax: |