Healthcare Provider Details

I. General information

NPI: 1023241502
Provider Name (Legal Business Name): JENNIFER PALMIOTTO M.A., MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 SHELTER ISLAND DR SUITE 216
SAN DIEGO CA
92106-2743
US

IV. Provider business mailing address

3405 WISTERIA DR
SAN DIEGO CA
92106-1147
US

V. Phone/Fax

Practice location:
  • Phone: 619-301-3452
  • Fax: 619-224-9508
Mailing address:
  • Phone: 619-301-3452
  • Fax: 619-224-9508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number47573
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number47573
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: