Healthcare Provider Details

I. General information

NPI: 1477858355
Provider Name (Legal Business Name): MRS. KAREN CYNTHIA JEMISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 E 1ST ST SUITE #100
SANTA ANA CA
92701-6341
US

IV. Provider business mailing address

1309 N REMBRANDT CIR
ORANGE CA
92867-5238
US

V. Phone/Fax

Practice location:
  • Phone: 714-972-3700
  • Fax:
Mailing address:
  • Phone: 714-289-1192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: