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General NPI Number Information
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NPI Number | 1679808067
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Entity Type | Individual
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Provider Name | JENNIFER KOLI SIRCAR
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Gender | Female
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Dates
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Enumeration Date | 10/02/2009
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | LOMA LINDA VA HEALTHCARE SYSTEM 11201 BENTON ST
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City | LOMA LINDA
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State | CA
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Zip | 92357-3905
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Country | US
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Telephone | 909-825-7084
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Fax |
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Provider Business Mailing Address
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Address Line | 11201 BENTON ST (VALOR #122)
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City | LOMA LINDA
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State | CA
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Zip | 92357-0001
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Country | US
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Telephone | 909-825-7084
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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 | 1041C0700X
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Taxonomy Name | Clinical 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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | Q1-0001433
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License Number State | DC
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