Provider Demographics
NPI:1467719484
Name:FALK, JENNIFER NICOLE (DPM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NICOLE
Last Name:FALK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12751 MILLENNIUM APT 421
Mailing Address - Street 2:
Mailing Address - City:PLAYA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:90094-2963
Mailing Address - Country:US
Mailing Address - Phone:310-310-1201
Mailing Address - Fax:
Practice Address - Street 1:12751 MILLENNIUM APT 421
Practice Address - Street 2:
Practice Address - City:PLAYA VISTA
Practice Address - State:CA
Practice Address - Zip Code:90094-2963
Practice Address - Country:US
Practice Address - Phone:310-310-1201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-15
Last Update Date:2023-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5195213E00000X, 213E00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program