Basic Information
| Provider Information | |||||||||
| NPI: | 1629620620 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRIFFITHS | ||||||||
| FirstName: | JAELIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2025 E 7TH ST | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908044590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622851330 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1301 E ORANGEWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928056807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002491266 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2019 | ||||||||
| LastUpdateDate: | 10/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y | 171M00000X | CA | N | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.