Healthcare Provider Details

I. General information

NPI: 1821776550
Provider Name (Legal Business Name): JENNIFER MAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 ENCINITAS AVE
SAN DIEGO CA
92114-4914
US

IV. Provider business mailing address

519 ENCINITAS AVE
SAN DIEGO CA
92114-4914
US

V. Phone/Fax

Practice location:
  • Phone: 619-573-2347
  • Fax:
Mailing address:
  • Phone: 619-573-2347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number162668
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number162668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: