=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114234291
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MS. JENNIFER VALLEJO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2010
-----------------------------------------------------
Last Update Date | 11/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24330 NARBONNE AVE
-----------------------------------------------------
City | LOMITA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90717-1131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-534-1083
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11715 PATTON RD
-----------------------------------------------------
City | DOWNEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90241-5234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-644-8662
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------