Provider Demographics
NPI:1467065789
Name:PARTIDA, JENNIFER ALEJANDRA
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ALEJANDRA
Last Name:PARTIDA
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 1:12650 SUNDOWN RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-7512
Mailing Address - Country:US
Mailing Address - Phone:442-229-2142
Mailing Address - Fax:
Practice Address - Street 1:12650 SUNDOWN RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-7512
Practice Address - Country:US
Practice Address - Phone:442-229-2142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker