Provider Demographics
NPI:1275630162
Name:VRADENBURG-HAWORTH, JENNIFER (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:VRADENBURG-HAWORTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:REEDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93654-2096
Mailing Address - Country:US
Mailing Address - Phone:559-391-3115
Mailing Address - Fax:559-391-3117
Practice Address - Street 1:550 W CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:REEDLEY
Practice Address - State:CA
Practice Address - Zip Code:93654-2096
Practice Address - Country:US
Practice Address - Phone:559-391-3115
Practice Address - Fax:559-391-3117
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74822207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G748220Medicaid