Provider Demographics
NPI:1184817249
Name:FLEMING, JENNIFER CLAUDIA (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CLAUDIA
Last Name:FLEMING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:CLAUDIA
Other - Last Name:HADJES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1612 S BUNDY DR APT 5
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2638
Mailing Address - Country:US
Mailing Address - Phone:310-423-5000
Mailing Address - Fax:310-967-1800
Practice Address - Street 1:8700 BEVERLY BLVD.
Practice Address - Street 2:ROOM 6215
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1865
Practice Address - Country:US
Practice Address - Phone:310-423-6429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16670363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1184608002Medicaid
CACB343YMedicare PIN