Gustin, Mary Jo
Gustin, Mary Jo is an sole proprietor health care provider with primary practice located at 11710 Wilshire Blvd , Los Angeles CA 90025-1503. She recently has 2 registered licenses in different health care specialties including Chiropractic Providers / Chiropractor, Chiropractic Providers / Rehabilitation. Chiropractic Providers / Rehabilitation is her primary health care specialty. Gustin, Mary Jo can be contacted via phone (310) 873-4422.Contact Information
Primary practice address
11710 Wilshire Blvd
Los Angeles CA 90025-1503
Phone: (310) 873-4422
Fax: (310) 873-4434
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Chiropractic Providers / Chiropractor | 111N00000X | 263-0796 | New Hampshire |
| Chiropractic Providers / Rehabilitation | 111NR0400X | 17484 | California |
Profile Details
| NPI number | 1447365655 |
|---|---|
| LBN Legal business name | Gustin, Mary Jo |
| Credentials | Doctor of Chiropractic (DC) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 20th, 2006 |
| Last updated | Sep 3rd, 2015 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1447365655 | NPPES |
| New Hampshire | MEDICAID | 30251443 |
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