Healthcare Provider Details

I. General information

NPI: 1154600179
Provider Name (Legal Business Name): JENAE RAINERI R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 08/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W SANTA ANA BLVD SUITE 405
SANTA ANA CA
92701-4558
US

IV. Provider business mailing address

5255 E SPRING ST
LONG BEACH CA
90808-3517
US

V. Phone/Fax

Practice location:
  • Phone: 714-565-3780
  • Fax: 714-565-3788
Mailing address:
  • Phone: 714-884-2201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number574546
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: