Provider Demographics
NPI:1265760623
Name:BEDOLLA, JESUS FRANCO
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:FRANCO
Last Name:BEDOLLA
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 1:5923 MALABAR ST
Mailing Address - Street 2:13
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-7148
Mailing Address - Country:US
Mailing Address - Phone:323-582-3705
Mailing Address - Fax:
Practice Address - Street 1:2677 ZOE AVE
Practice Address - Street 2:303
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4195
Practice Address - Country:US
Practice Address - Phone:323-312-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner