Healthcare Provider Details

I. General information

NPI: 1437799541
Provider Name (Legal Business Name): JENNY JESMER CASTRO REXACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20032-2601
US

IV. Provider business mailing address

821 OTIS PL NW
WASHINGTON DC
20010-1515
US

V. Phone/Fax

Practice location:
  • Phone: 954-790-5556
  • Fax:
Mailing address:
  • Phone: 202-491-0742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN1027432
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: