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General NPI Number Information
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NPI Number | 1114459021
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Entity Type | Individual
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Provider Name | DONNISE FENNELL
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Gender | Female
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Dates
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Enumeration Date | 03/30/2017
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 1045 W REDONDO BEACH BLVD
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City | GARDENA
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State | CA
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Zip | 90247-4128
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Country | US
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Telephone | 310-689-9699
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Fax | 310-689-9699
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Provider Business Mailing Address
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Address Line | 1501 HUGHES WAY SUITE 150
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City | LONG BEACH
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State | CA
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Zip | 90810-1876
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Country | US
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Telephone | 310-221-6336
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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