Healthcare Provider Details

I. General information

NPI: 1992070221
Provider Name (Legal Business Name): JENNIFER ALTHEA CARBAJAL N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14350 E. WHITTIER BLV.
WHITTIER CA
90605
US

IV. Provider business mailing address

14350 E. WHITTIER BLV. SUITE #200
WHITTIER CA
90605
US

V. Phone/Fax

Practice location:
  • Phone: 562-945-7671
  • Fax: 562-945-7485
Mailing address:
  • Phone: 562-945-7671
  • Fax: 562-945-7485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN410767
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN410767
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: