1225351513 NPI number — MS. JENNIFER SHULLEN A.A., B.A, AOD CERT.

Table of content: MS. JENNIFER SHULLEN A.A., B.A, AOD CERT. (NPI 1225351513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225351513 NPI number — MS. JENNIFER SHULLEN A.A., B.A, AOD CERT.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHULLEN
Provider First Name:
JENNIFER
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
A.A., B.A, AOD CERT.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225351513
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14451 BENEFIT ST
Provider Second Line Business Mailing Address:
3
Provider Business Mailing Address City Name:
SHERMAN OAKS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91423-4052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-625-4922
Provider Business Mailing Address Fax Number:
818-788-1390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14435 HAMLIN ST
Provider Second Line Business Practice Location Address:
102
Provider Business Practice Location Address City Name:
VAN NUYS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91401-6205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-997-1930
Provider Business Practice Location Address Fax Number:
818-997-1905
Provider Enumeration Date:
03/01/2010

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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