Healthcare Provider Details

I. General information

NPI: 1376928358
Provider Name (Legal Business Name): JENNIFER ADRIANA THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 W 226TH ST
TORRANCE CA
90505-2340
US

IV. Provider business mailing address

2540 CHARLESTON ST
OAKLAND CA
94602-2508
US

V. Phone/Fax

Practice location:
  • Phone: 310-373-4556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number98394
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: