Healthcare Provider Details

I. General information

NPI: 1093968810
Provider Name (Legal Business Name): MRS. JENNIFER L CUEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3645 RUFFIN RD STE 100
SAN DIEGO CA
92123-1875
US

IV. Provider business mailing address

3645 RUFFIN RD SUITE 100
SAN DIEGO CA
92123-6602
US

V. Phone/Fax

Practice location:
  • Phone: 858-384-6284
  • Fax: 858-384-6453
Mailing address:
  • Phone: 858-384-6284
  • Fax: 858-384-6453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: