Healthcare Provider Details

I. General information

NPI: 1790228690
Provider Name (Legal Business Name): JENNIFER NAAMANI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2016
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14677 MERRILL AVE
FONTANA CA
92335-4219
US

IV. Provider business mailing address

14677 MERRILL AVE
FONTANA CA
92335-4219
US

V. Phone/Fax

Practice location:
  • Phone: 951-643-2340
  • Fax:
Mailing address:
  • Phone: 951-643-2340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number141266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: