Individual
ADAM JENNINGS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
15305 RAYEN ST, NORTH HILLS, CA 91343-5117
(818) 892-3423
Mailing address
15305 RAYEN ST, NORTH HILLS, CA 91343-5117
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95-2633765
MEDI-CAL
CA
Enumeration date
07/19/2018
Last updated
07/19/2018
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