Healthcare Provider Details

I. General information

NPI: 1447129762
Provider Name (Legal Business Name): JENNIFER ZICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 1/2 ACACIA AVE
CORONA DEL MAR CA
92625-1975
US

IV. Provider business mailing address

704 1/2 ACACIA AVE
CORONA DEL MAR CA
92625-1975
US

V. Phone/Fax

Practice location:
  • Phone: 949-342-6572
  • Fax:
Mailing address:
  • Phone: 949-342-6572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: