Healthcare Provider Details

I. General information

NPI: 1720897952
Provider Name (Legal Business Name): JENNIFER KING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER COLE

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 12/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12004 CARMEL MOUNTAIN RD STUDIO 57 & 58
SAN DIEGO CA
92128
US

IV. Provider business mailing address

557 SOUTH MEADOWS PARKWAY UNIT 200, STUDIO 12
RENO NV
89521
US

V. Phone/Fax

Practice location:
  • Phone: 858-210-5109
  • Fax:
Mailing address:
  • Phone: 858-210-5109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: