Provider Demographics
NPI:1033794136
Name:CLAVO, JENY DOMINGO (CMA)
Entity Type:Individual
Prefix:
First Name:JENY
Middle Name:DOMINGO
Last Name:CLAVO
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8279 FIELDPOPPY CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-4906
Mailing Address - Country:US
Mailing Address - Phone:408-420-4769
Mailing Address - Fax:
Practice Address - Street 1:8279 FIELDPOPPY CIR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-4906
Practice Address - Country:US
Practice Address - Phone:408-420-4769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program