Basic Information
| Provider Information | |||||||||
| NPI: | 1710229497 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STURM | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5251 VINELAND AVE | ||||||||
| Address2: | APT. 417 | ||||||||
| City: | NORTH HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916017001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617551522 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6736 LAUREL CANYON BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | NORTH HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916061538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187558786 | ||||||||
| FaxNumber: | 8187558789 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2013 | ||||||||
| LastUpdateDate: | 12/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | D5199766 | CA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.