Provider Demographics
NPI:1417447186
Name:DR. MINDI L. JENTES
Entity Type:Organization
Organization Name:DR. MINDI L. JENTES
Other - Org Name:BRIO WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANTE
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-598-2746
Mailing Address - Street 1:4132 KATELLA AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-6601
Mailing Address - Country:US
Mailing Address - Phone:562-598-2746
Mailing Address - Fax:
Practice Address - Street 1:4132 KATELLA AVE STE 204
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6601
Practice Address - Country:US
Practice Address - Phone:562-598-2746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33030111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID