Individual
JERRY JOHN EDOLOVERIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12021 WILMINGTON AVENUE, BUILDING 18, SUITE 101, LOS ANGELES, CA 90059
(424) 454-6001
Mailing address
12021 WILMINGTON AVE., BUILDING 18, SUITE 101, LOS ANGELES, CA 90059
(424) 454-6001
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
705143
CA
Other
Enumeration date
05/15/2024
Last updated
06/26/2025
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