Provider Demographics
NPI:1891211363
Name:JTY AND ASSOCIATES, LLC
Entity Type:Organization
Organization Name:JTY AND ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:OLAGUERA
Authorized Official - Last Name:TY-DE GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:562-331-8881
Mailing Address - Street 1:14025 PARAMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-2605
Mailing Address - Country:US
Mailing Address - Phone:562-331-8881
Mailing Address - Fax:562-988-3373
Practice Address - Street 1:14025 PARAMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-2605
Practice Address - Country:US
Practice Address - Phone:562-331-8881
Practice Address - Fax:562-988-3373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP12561261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service