Healthcare Provider Details

I. General information

NPI: 1740139955
Provider Name (Legal Business Name): BRANDEN A JENNINGS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 01/22/2026
Certification Date: 01/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 DUDLEY BOULEVARD, MCCLELLAN PARK, CA
MCCLELLAN PARK CA
95652
US

IV. Provider business mailing address

9124 BRUCEVILLE RD APT 3036
ELK GROVE CA
95758-8463
US

V. Phone/Fax

Practice location:
  • Phone: 916-567-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: