Healthcare Provider Details

I. General information

NPI: 1275702326
Provider Name (Legal Business Name): JENNIFER CORTEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER INCHAURREGUI

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 HILLMONT AVE
VENTURA CA
93003-1651
US

IV. Provider business mailing address

966 EVERGREEN LN
PORT HUENEME CA
93041-2651
US

V. Phone/Fax

Practice location:
  • Phone: 805-233-7750
  • Fax:
Mailing address:
  • Phone: 805-616-8725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: