Individual
MR. JACK BOOKER ANDERSON II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
879 W 190TH ST STE 400, GARDENA, CA 90248-4223
(310) 887-6382
Mailing address
PO BOX 470323, LOS ANGELES, CA 90047-0323
(310) 490-7570
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
CA
Other
Enumeration date
06/25/2021
Last updated
02/07/2023
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