Active NPI
Jerry John Edoloverio
- Addiction (Substance Use Disorder) Registered Nurse
- Los Angeles, CA
National Provider Identifier
1437908282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Registered Nurse
- License
- 705143
- Practice address
- 12021 Wilmington Avenue
Building 18, Suite 101
Los Angeles, CA 90059 - Phone
- (424) 454-6001
- NPI assigned
- May 15, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Registered Nurse | 163WA0400X | 705143 | CA | Primary |
Addresses
Primary practice location
12021 Wilmington Avenue
Building 18, Suite 101
Los Angeles, CA 90059
Mailing address
12021 Wilmington Ave.
Building 18, Suite 101
Los Angeles, CA 90059
Phone (424) 454-6001
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 705143 | CA | MD | Addiction (Substance Use Disorder) Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1715731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750896000000",
"number": "1437908282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12021 WILMINGTON AVE.",
"address_2": "BUILDING 18, SUITE 101",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90059",
"telephone_number": "424-454-6001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12021 WILMINGTON AVENUE",
"address_2": "BUILDING 18, SUITE 101",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90059",
"telephone_number": "424-454-6001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDOLOVERIO",
"first_name": "JERRY JOHN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-05-15",
"last_updated": "2025-06-26",
"certification_date": "2025-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "163WA0400X",
"taxonomy_group": "",
"desc": "Registered Nurse, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "705143",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.