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1447849104
JONATHAN EDWARD PANUELOS EVIDENTE
ORANGE, CA
NPI
1447849104
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
163WP0808X Registered Nurse, Psych/Mental Health
(Licence: CA 95285762)
Enumeration Date
2021-01-15
Last Update Date
2023-12-12
Business Address
JONATHAN EDWARD PANUELOS EVIDENTE
265 S ANITA DR STE 102-104
ORANGE, CA 92868-3355
Phone number: 310-945-3350
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Mailing Address
JONATHAN EDWARD PANUELOS EVIDENTE
9808 VENICE BLVD STE 505
CULVER CITY, CA 90232-6818
Phone number: 310-945-3350
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