Healthcare Provider Details

I. General information

NPI: 1366357196
Provider Name (Legal Business Name): JENNA STEPHANOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 W 139TH ST
GARDENA CA
90247-2212
US

IV. Provider business mailing address

1316 W 139TH ST
GARDENA CA
90247-2212
US

V. Phone/Fax

Practice location:
  • Phone: 424-375-5353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: