Healthcare Provider Details

I. General information

NPI: 1164255337
Provider Name (Legal Business Name): JENNIFER GARCIA URENO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 N GARDEN ST
ANAHEIM CA
92801-3420
US

IV. Provider business mailing address

924 N GARDEN ST
ANAHEIM CA
92801-3420
US

V. Phone/Fax

Practice location:
  • Phone: 661-433-5153
  • Fax:
Mailing address:
  • Phone: 661-433-5153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86358738
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: