1154335172 NPI number — MRS. JENNIFER LYN CARDILLO M.A.

Table of content: MRS. JENNIFER LYN CARDILLO M.A. (NPI 1154335172)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154335172 NPI number — MRS. JENNIFER LYN CARDILLO M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARDILLO
Provider First Name:
JENNIFER
Provider Middle Name:
LYN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STRAUSS
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
LYN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154335172
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2595 E PERRIN AVE
Provider Second Line Business Mailing Address:
SUITE 113
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93720-5202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-824-2277
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2595 E PERRIN AVE STE 113
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93720-5202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-824-2277
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC 41706 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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