Provider Demographics
NPI:1467220533
Name:ONEAL, JENNIFER ELAINE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELAINE
Last Name:ONEAL
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 1:516 W PLUM STREET, COMPTON
Mailing Address - Street 2:COMPTON
Mailing Address - City:CA
Mailing Address - State:CA
Mailing Address - Zip Code:90222
Mailing Address - Country:US
Mailing Address - Phone:626-638-5252
Mailing Address - Fax:
Practice Address - Street 1:516 W PLUM STREET, COMPTON
Practice Address - Street 2:COMPTON
Practice Address - City:CA
Practice Address - State:CA
Practice Address - Zip Code:90222-9022
Practice Address - Country:US
Practice Address - Phone:626-638-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93-461278310400000X, 311ZA0620X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home