Basic Information
| Provider Information | |||||||||
| NPI: | 1598962912 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANSPARD | ||||||||
| FirstName: | JERMAINE | ||||||||
| MiddleName: | L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19012 ANNALEE AVE | ||||||||
| Address2: | |||||||||
| City: | CARSON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907462612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232224591 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3125 N BROADWAY | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900312703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232224591 | ||||||||
| FaxNumber: | 3232224614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.