Healthcare Provider Details

I. General information

NPI: 1598042558
Provider Name (Legal Business Name): JENNIFER MARIE JANVRIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44447 10TH ST W
LANCASTER CA
93534-3324
US

IV. Provider business mailing address

44447 10TH ST W
LANCASTER CA
93534-3324
US

V. Phone/Fax

Practice location:
  • Phone: 661-726-2630
  • Fax: 661-723-3211
Mailing address:
  • Phone: 661-726-2630
  • Fax: 661-723-3211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberJ1002101018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: