MEDICARE: JENNA LOUISE SETO D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	32249	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GB288A	OTHER	CA	MEDICARE PTAN

General Provider Information

NPI Number	:	1508122524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA LOUISE SETO D.C.

Provider Business Mailing Address
First Line	:	11610 IBERIA PL
Second Line	:	SUITE 102
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-2407
Country	:	US
Telephone Number	:	858-848-5671
Fax Number	:

Provider Business Practice Location Address
First Line	:	11610 IBERIA PL
Second Line	:	SUITE 102
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-2407
Country	:	US
Telephone Number	:	858-848-5671
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2012
Last Update Date	:	11/29/2016

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