Provider Demographics
NPI:1295061554
Name:MARVAN, JARDINE POSADAS (NP)
Entity type:Individual
Prefix:
First Name:JARDINE
Middle Name:POSADAS
Last Name:MARVAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JARDINE
Other - Middle Name:POSADAS
Other - Last Name:DIZON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3521 GREENSWARD RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2110
Mailing Address - Country:US
Mailing Address - Phone:323-363-9226
Mailing Address - Fax:
Practice Address - Street 1:2011 WILSHIRE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3503
Practice Address - Country:US
Practice Address - Phone:213-413-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA19221OtherSTATE BOARD