Provider Demographics
NPI:1821859091
Name:KARIUKI, JONATHAN MAX
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MAX
Last Name:KARIUKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1643 COLBY AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3043
Mailing Address - Country:US
Mailing Address - Phone:310-663-2848
Mailing Address - Fax:
Practice Address - Street 1:1643 COLBY AVE APT 5
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3043
Practice Address - Country:US
Practice Address - Phone:310-663-2848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72511225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist