1437490430 NPI number — JENNIFER JEAN GARDNER-CARDANI RD, CDE

Table of content: JENNIFER JEAN GARDNER-CARDANI RD, CDE (NPI 1437490430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437490430 NPI number — JENNIFER JEAN GARDNER-CARDANI RD, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARDNER-CARDANI
Provider First Name:
JENNIFER
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD, CDE
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:
1437490430
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
911 CERISE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TORRANCE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90503-5203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
424-247-3866
Provider Business Mailing Address Fax Number:
310-326-6022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2841 LOMITA BLVD
Provider Second Line Business Practice Location Address:
SUITE 335
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90505-5116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-891-6707
Provider Business Practice Location Address Fax Number:
310-326-6022
Provider Enumeration Date:
03/15/2013

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: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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