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NPI Code Detail

MEDICARE: JENNIFER LYNNE JOY CORNEJO

MEDICARE:   JENNIFER LYNNE JOY CORNEJO
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
1231H00000XAudiologistA-196NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1992972293
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER LYNNE JOY CORNEJO
Provider Business Mailing Address
First Line : 3016 W CHARLESTON BLVD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1973
Country : US
Telephone Number : 818-451-9016
Fax Number : 702-895-4014
Provider Business Practice Location Address
First Line : 5320 S RAINBOW BLVD STE 250
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-1896
Country : US
Telephone Number : 702-671-6480
Fax Number : 702-671-6481
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2008
Last Update Date : 11/09/2020

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Directions to “ JENNIFER LYNNE JOY CORNEJO ” Practice Location

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