Provider Demographics
NPI:1942483185
Name:ABRAMS, JACQUELINE (MPH, CHES, AE-C)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:ABRAMS
Suffix:
Gender:F
Credentials:MPH, CHES, AE-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 W OLYMPIC BLVD
Mailing Address - Street 2:ROOM 7
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-1329
Mailing Address - Country:US
Mailing Address - Phone:213-861-5852
Mailing Address - Fax:213-861-5973
Practice Address - Street 1:1025 W OLYMPIC BLVD
Practice Address - Street 2:ROOM 7
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-1329
Practice Address - Country:US
Practice Address - Phone:213-861-5852
Practice Address - Fax:213-861-5973
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACHES 10150172V00000X
CAAE-C 1122172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker