Healthcare Provider Details

I. General information

NPI: 1578897591
Provider Name (Legal Business Name): JENIVI LAU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENIVI MARUCUT PA-C

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 FIVEPOINT
IRVINE CA
92618-2621
US

IV. Provider business mailing address

26732 CROWN VALLEY PKWY STE 351
MISSION VIEJO CA
92691-6374
US

V. Phone/Fax

Practice location:
  • Phone: 800-826-4673
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2293
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number21199
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: