Healthcare Provider Details

I. General information

NPI: 1942893037
Provider Name (Legal Business Name): JENI D DAVENPORT-FURNISS NBC-HWC, CHES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER DAWN DAVENPORT NBC-HWC, CHES

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 06/19/2024
Certification Date: 04/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6460 CONVOY CT SPACE 129
SAN DIEGO CA
92117
US

IV. Provider business mailing address

4231 BALBOA AVE # 3040
SAN DIEGO CA
92117-5504
US

V. Phone/Fax

Practice location:
  • Phone: 858-361-2286
  • Fax:
Mailing address:
  • Phone: 858-361-2286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number630902131
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number7365
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: