Healthcare Provider Details

I. General information

NPI: 1578508503
Provider Name (Legal Business Name): JENNIFER A FAGGIONATO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER DAL POGGETTO

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12401 WASHINGTON BLVD
WHITTIER CA
90602-1006
US

IV. Provider business mailing address

PO BOX 4419
WOODLAND HILLS CA
91365-4419
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-0811
  • Fax: 818-587-2493
Mailing address:
  • Phone: 800-506-6895
  • Fax: 818-587-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: