Healthcare Provider Details

I. General information

NPI: 1104265719
Provider Name (Legal Business Name): JENNIFER RACHEL PATTERSON BC-HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24445 HAWTHORNE BLVD STE. 109
TORRANCE CA
90505-6562
US

IV. Provider business mailing address

555 ROSEWOOD AVE APT. 207
CAMARILLO CA
93010-5925
US

V. Phone/Fax

Practice location:
  • Phone: 310-893-6113
  • Fax:
Mailing address:
  • Phone: 702-335-1276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA 7740
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number310
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: