Healthcare Provider Details

I. General information

NPI: 1265873392
Provider Name (Legal Business Name): JENIFERS HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2046 SIMON AVE
SAN JOSE CA
95122-1607
US

IV. Provider business mailing address

2046 SIMON AVE
SAN JOSE CA
95122-1607
US

V. Phone/Fax

Practice location:
  • Phone: 408-347-8517
  • Fax:
Mailing address:
  • Phone: 408-347-8517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC15474
License Number StateCA

VIII. Authorized Official

Name: GENE SELIG
Title or Position: OWNER
Credential:
Phone: 408-347-8517