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General NPI Number Information
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NPI Number | 1962674242
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Entity Type | Individual
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Provider Name | JENNIFER BANH B.A.
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Gender | Female
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 9353 E VALLEY BLVD
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City | ROSEMEAD
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State | CA
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Zip | 91770
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Country | US
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Telephone | 626-780-8174
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Fax |
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Provider Business Mailing Address
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Address Line | 3323 N DELTA AVENUE
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City | ROSEMEAD
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State | CA
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Zip | 91770-2634
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Country | US
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Telephone | 626-571-0072
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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 | 174400000X
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Taxonomy Name | Specialist
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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