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Individual

JENNIE M LUXON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
3065 VALEVISTA TRL, LOS ANGELES, CA 90068-1724
(424) 254-8242
Mailing address
3065 VALEVISTA TRL, LOS ANGELES, CA 90068-1724
(424) 254-8242

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
33235
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01536011
MEDI-CAL
CA
Enumeration date
11/08/2019
Last updated
02/02/2023
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