MEDICARE: JENNIFER PATRICIA ORNELAS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW73858	CA

General Provider Information

NPI Number	:	1639612625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER PATRICIA ORNELAS LCSW

Provider Business Mailing Address
First Line	:	4567 RUEDA DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-2239
Country	:	US
Telephone Number	:	619-573-0293
Fax Number	:

Provider Business Practice Location Address
First Line	:	4567 RUEDA DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92124-2239
Country	:	US
Telephone Number	:	619-573-0293
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2016
Last Update Date	:	11/23/2016

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Directions to “ JENNIFER PATRICIA ORNELAS LCSW” Practice Location

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