Healthcare Provider Details

I. General information

NPI: 1043511223
Provider Name (Legal Business Name): MS. JENNIFER OLIVIA FRIEND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 E FRUIT ST
SANTA ANA CA
92701-4206
US

IV. Provider business mailing address

1100 CLEGHORN DR UNIT D
DIAMOND BAR CA
91765-2313
US

V. Phone/Fax

Practice location:
  • Phone: 714-953-9373
  • Fax:
Mailing address:
  • Phone: 909-569-2263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number98492
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: