Provider Demographics
NPI:1073211769
Name:VENEGAS, JESSICA JESUS
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JESUS
Last Name:VENEGAS
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 1:4444 E AVENUE R SPC 66
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93552-6709
Mailing Address - Country:US
Mailing Address - Phone:661-227-8785
Mailing Address - Fax:
Practice Address - Street 1:4444 E AVENUE R SPC 66
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-6709
Practice Address - Country:US
Practice Address - Phone:661-227-8785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty