Provider Demographics
NPI:1326580317
Name:SABOVICH, JENNIFER GEORGIA LYNN (RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GEORGIA LYNN
Last Name:SABOVICH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:GEORGIA
Other - Middle Name:
Other - Last Name:SABOVICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:9187 COCKATOO AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6511
Mailing Address - Country:US
Mailing Address - Phone:714-264-8555
Mailing Address - Fax:
Practice Address - Street 1:9187 COCKATOO AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6511
Practice Address - Country:US
Practice Address - Phone:714-264-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA791337163WX0106X, 163W00000X, 163WC0400X, 163WC1500X, 163WC1600X, 171M00000X, 174H00000X, 372500000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator
No372500000XNursing Service Related ProvidersChore Provider
No374U00000XNursing Service Related ProvidersHome Health Aide