Healthcare Provider Details

I. General information

NPI: 1124333067
Provider Name (Legal Business Name): JENNIFER ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 LEXINGTON AVE
EL MONTE CA
91731-2608
US

IV. Provider business mailing address

24311 SWIFT DEER TRL
CORONA CA
92883-5448
US

V. Phone/Fax

Practice location:
  • Phone: 626-453-3700
  • Fax: 626-442-1063
Mailing address:
  • Phone: 951-277-1494
  • 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: