Provider Demographics
NPI:1003307190
Name:HAROUN, JENNIFER GHOBRIAL (LAC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:GHOBRIAL
Last Name:HAROUN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 READING AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-4347
Mailing Address - Country:US
Mailing Address - Phone:310-963-1568
Mailing Address - Fax:
Practice Address - Street 1:12112 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5514
Practice Address - Country:US
Practice Address - Phone:424-501-4391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18038171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty