Healthcare Provider Details

I. General information

NPI: 1760723142
Provider Name (Legal Business Name): JENNIFER MARIE VACHET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2013
Last Update Date: 10/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24050 MADISON ST STE 200
TORRANCE CA
90505-6016
US

IV. Provider business mailing address

PO BOX 2557
MANHATTAN BEACH CA
90267-2557
US

V. Phone/Fax

Practice location:
  • Phone: 310-780-3375
  • Fax:
Mailing address:
  • Phone: 310-780-3375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number70014
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number93600
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: