Provider Demographics
NPI:1669027819
Name:BYRNE, JADA (DACM, LAC)
Entity Type:Individual
Prefix:DR
First Name:JADA
Middle Name:
Last Name:BYRNE
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 W AVENUE 28 APT 5
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-1546
Mailing Address - Country:US
Mailing Address - Phone:323-316-5483
Mailing Address - Fax:
Practice Address - Street 1:2221 PALO VERDE AVE STE 1J
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-2360
Practice Address - Country:US
Practice Address - Phone:562-239-9418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA18192171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist