Provider Demographics
NPI:1386189769
Name:MAI, JESSICA (LVN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MAI
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19208 CAMPAIGN DR
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-2022
Mailing Address - Country:US
Mailing Address - Phone:310-808-4186
Mailing Address - Fax:
Practice Address - Street 1:19208 CAMPAIGN DR
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-2022
Practice Address - Country:US
Practice Address - Phone:310-808-4186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN281047164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse