Healthcare Provider Details

I. General information

NPI: 1821989542
Provider Name (Legal Business Name): JENIFER MOHLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 E SANTA CLARA ST
SAN JOSE CA
95113-1936
US

IV. Provider business mailing address

137 FAIRMOUNT AVE
SANTA CRUZ CA
95062-1115
US

V. Phone/Fax

Practice location:
  • Phone: 669-245-3428
  • Fax: 408-800-4095
Mailing address:
  • Phone: 301-861-8650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: