Individual
JEROME PRUDENCIO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
145 S FAIRFAX AVE FL 2, LOS ANGELES, CA 90036-2166
(310) 502-8089
Mailing address
8816 LA RIVIERA DR UNIT D, SACRAMENTO, CA 95826-2075
(310) 502-8089
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
08/05/2020
Last updated
09/09/2025
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