Provider Demographics
NPI:1396223889
Name:HEBARD, JOLISSA EVELYN
Entity Type:Individual
Prefix:
First Name:JOLISSA
Middle Name:EVELYN
Last Name:HEBARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2646 OSTROM AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1601
Mailing Address - Country:US
Mailing Address - Phone:714-916-2910
Mailing Address - Fax:
Practice Address - Street 1:2646 OSTROM AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1601
Practice Address - Country:US
Practice Address - Phone:714-916-2910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist