Healthcare Provider Details

I. General information

NPI: 1285312819
Provider Name (Legal Business Name): JOHN JENNINGS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 W LACEY BLVD
HANFORD CA
93230-5901
US

IV. Provider business mailing address

1222 W LACEY BLVD
HANFORD CA
93230-5901
US

V. Phone/Fax

Practice location:
  • Phone: 559-235-9239
  • Fax:
Mailing address:
  • Phone: 559-235-9239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number114706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: