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Organization

JENICE STANIFORD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. JENICE LORENA STANIFORD MFT (THERAPIST)
(619) 286-0677
Entity
Organization

Contact information

Practice address
4626 59TH ST, SAN DIEGO, CA 92115-3830
(619) 286-0677
Mailing address
4626 59TH ST, SAN DIEGO, CA 92115-3830
(619) 286-0677

Taxonomy

Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
MLO21394
CA

Other

Enumeration date
11/21/2008
Last updated
11/21/2008
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