Healthcare Provider Details

I. General information

NPI: 1669881199
Provider Name (Legal Business Name): MS. JENNA SOPHIA WADSWORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116A W 4TH ST UNIT 14
SANTA ANA CA
92701-6715
US

IV. Provider business mailing address

116A W 4TH ST UNIT 14
SANTA ANA CA
92701-6715
US

V. Phone/Fax

Practice location:
  • Phone: 949-701-5709
  • Fax:
Mailing address:
  • Phone: 949-701-5709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: