Healthcare Provider Details

I. General information

NPI: 1528421740
Provider Name (Legal Business Name): JENESSA K. JOB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

525 E 68TH ST BOX 124
NEW YORK NY
10065-4870
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-1447
  • Fax:
Mailing address:
  • Phone: 212-746-2941
  • Fax: 646-962-1920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA168438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: