Healthcare Provider Details

I. General information

NPI: 1336068188
Provider Name (Legal Business Name): JENNIFER WALTHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31625 HIGHWAY 101 S
SOLEDAD CA
93960-9529
US

IV. Provider business mailing address

849 ALMAR AVE # C457
SANTA CRUZ CA
95060-5875
US

V. Phone/Fax

Practice location:
  • Phone: 831-678-5500
  • Fax:
Mailing address:
  • Phone:
  • 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: