Provider Demographics
NPI:1114320124
Name:EZIRIM-SALAMIALOFOJE, JOVITA (NP)
Entity Type:Individual
Prefix:
First Name:JOVITA
Middle Name:
Last Name:EZIRIM-SALAMIALOFOJE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JOVITA
Other - Middle Name:
Other - Last Name:EZIRIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8401 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-3423
Mailing Address - Country:US
Mailing Address - Phone:323-789-6492
Mailing Address - Fax:323-967-0180
Practice Address - Street 1:8401 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-3423
Practice Address - Country:US
Practice Address - Phone:323-789-6492
Practice Address - Fax:323-967-0180
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001335363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health