Healthcare Provider Details

I. General information

NPI: 1003116609
Provider Name (Legal Business Name): JENNIFER ABERCROMBIE N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER FISHER N.D.

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 N SEPULVEDA BLVD SUITE 1140
EL SEGUNDO CA
90245-4475
US

IV. Provider business mailing address

390 N SEPULVEDA BLVD SUITE 1140
EL SEGUNDO CA
90245-4475
US

V. Phone/Fax

Practice location:
  • Phone: 310-926-4415
  • Fax: 619-342-4828
Mailing address:
  • Phone: 310-926-4415
  • Fax: 310-693-5492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND-426
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: