Healthcare Provider Details

I. General information

NPI: 1992972293
Provider Name (Legal Business Name): JENNIFER LYNNE JOY CORNEJO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNNE JOY CORNEJO MA

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 S RAINBOW BLVD STE 250
LAS VEGAS NV
89118-1896
US

IV. Provider business mailing address

3016 W CHARLESTON BLVD STE 100
LAS VEGAS NV
89102-1973
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-6480
  • Fax: 702-671-6481
Mailing address:
  • Phone: 818-451-9016
  • Fax: 702-895-4014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA-196
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: