Healthcare Provider Details

I. General information

NPI: 1356584882
Provider Name (Legal Business Name): JENNA BRE MARQUEZ LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNA ARCHIBALD LVN

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3373 KEARNY VILLA LN
SAN DIEGO CA
92123-1911
US

IV. Provider business mailing address

3373 KEARNY VILLA LANE
SAN DIEGO CA
92123
US

V. Phone/Fax

Practice location:
  • Phone: 858-336-2278
  • Fax:
Mailing address:
  • Phone: 858-336-2278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number233758
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: