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General NPI Number Information
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NPI Number | 1366175549
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Entity Type | Organization
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Legal Business Name | JENNYCO, INC.
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Dates
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Enumeration Date | 07/06/2022
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 5390 CAMINO SANTANDER
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City | SAN DIEGO
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State | CA
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Zip | 92130-6517
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Country | US
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Telephone | 978-621-4158
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Fax |
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Provider Business Mailing Address
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Address Line | 5390 CAMINO SANTANDER
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City | SAN DIEGO
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State | CA
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Zip | 92130-6517
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Country | US
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Telephone | 978-621-4158
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Fax |
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Authorized Official
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Title or Position | CHIEF TECHNICAL OFFICER
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Name | DR. STEPHEN CARTER
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Credential | PH.D.
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Telephone | 978-621-4158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083C0008X
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Taxonomy Name | Clinical Informatics Physician
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License Number |
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License Number State |
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