Healthcare Provider Details

I. General information

NPI: 1053226894
Provider Name (Legal Business Name): JENNETTE MARIE FRITCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

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

11201 BENTON RD
LOMA LINDA CA
92357-0001
US

IV. Provider business mailing address

53013 ALBA ST
LAKE ELSINORE CA
92532-1652
US

V. Phone/Fax

Practice location:
  • Phone: 909-780-3571
  • Fax:
Mailing address:
  • Phone: 951-249-4767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95132932
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: