Healthcare Provider Details

I. General information

NPI: 1073136487
Provider Name (Legal Business Name): JMJNT CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16766 BERNARDO CENTER DR STE 200
SAN DIEGO CA
92128-2502
US

IV. Provider business mailing address

16766 BERNARDO CENTER DR STE 200
SAN DIEGO CA
92128-2502
US

V. Phone/Fax

Practice location:
  • Phone: 858-866-8946
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JOHN BOODHANSINGH
Title or Position: PRESIDENT
Credential:
Phone: 858-866-8946