Healthcare Provider Details

I. General information

NPI: 1154770089
Provider Name (Legal Business Name): JENAE CIUFFREDA CSOM, CBBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 S HICKORY ST STE 207
ESCONDIDO CA
92025-4357
US

IV. Provider business mailing address

240 S HICKORY ST STE 207
ESCONDIDO CA
92025-4357
US

V. Phone/Fax

Practice location:
  • Phone: 760-580-5769
  • Fax: 760-746-4069
Mailing address:
  • Phone: 760-580-5769
  • Fax: 760-746-4069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: