Healthcare Provider Details

I. General information

NPI: 1932951605
Provider Name (Legal Business Name): JENNA MICHELLE SLOAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 ATLANTIC AVE
ALAMEDA CA
94501-1148
US

IV. Provider business mailing address

1005 ATLANTIC AVE
ALAMEDA CA
94501-1148
US

V. Phone/Fax

Practice location:
  • Phone: 415-474-7310
  • Fax:
Mailing address:
  • Phone: 415-474-7310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: