Healthcare Provider Details

I. General information

NPI: 1962194878
Provider Name (Legal Business Name): CYBIL RENEE JENKINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 LOMITA BLVD
TORRANCE CA
90505-5002
US

IV. Provider business mailing address

14931 S KINGSLEY DR
GARDENA CA
90247-3123
US

V. Phone/Fax

Practice location:
  • Phone: 310-325-9110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number95146805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: