Healthcare Provider Details

I. General information

NPI: 1386538437
Provider Name (Legal Business Name): JAGLENNA SAMANTHA LENOIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 SIERRA CT STE B6
PALMDALE CA
93550-7608
US

IV. Provider business mailing address

190 SIERRA CT STE B6
PALMDALE CA
93550-7608
US

V. Phone/Fax

Practice location:
  • Phone: 661-388-7149
  • Fax:
Mailing address:
  • Phone: 661-388-7149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: