Individual
JASON BOMBALES LASALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1225 W 190TH ST STE 280, GARDENA, CA 90248-4305
(310) 515-8113
(310) 538-2102
Mailing address
1225 W 190TH ST STE 280, GARDENA, CA 90248-4305
(310) 515-8113
(310) 538-2102
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95018499
CA
Other
Enumeration date
02/25/2022
Last updated
07/19/2022
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