Provider Demographics
NPI:1033766936
Name:MORISHITA, JENNA MARIA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIA
Last Name:MORISHITA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CASTRO ST
Mailing Address - Street 2:STE 210
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1038
Mailing Address - Country:US
Mailing Address - Phone:415-626-4900
Mailing Address - Fax:415-616-4901
Practice Address - Street 1:3838 CALIFORNIA ST RM 505
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1507
Practice Address - Country:US
Practice Address - Phone:415-751-4914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-25
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3435231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist