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General NPI Number Information
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NPI Number | 1760965966
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Entity Type | Individual
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Provider Name | MARIA FERNANDA JENKINSON CADC L CI22270620
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Gender | Female
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Dates
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Enumeration Date | 09/13/2018
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 2101 E 1ST ST
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City | SANTA ANA
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State | CA
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Zip | 92705-4007
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Country | US
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Telephone | 714-542-2246
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Fax | 714-906-0947
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Provider Business Mailing Address
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Address Line | 10520 LAKESIDE DR N UNIT J
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City | GARDEN GROVE
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State | CA
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Zip | 92840-5060
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Country | US
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Telephone | 562-388-5506
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CI22270620
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License Number State | CA
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