Individual
MRS. EUNICE JENNY BODAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
HCPD
Contact information
Practice address
1220 5TH AVE, LOS ANGELES, CA 90019-3445
(310) 780-7697
(310) 371-1249
Mailing address
2750 ARTESIA BLVD UNIT 117, REDONDO BEACH, CA 90278-3392
(310) 780-7697
(310) 371-1249
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
522662
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
372600000X
—
CA
Enumeration date
07/30/2010
Last updated
10/08/2015
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