Provider Demographics
NPI:1497079552
Name:STEWART, JENNIFER LORRAINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LORRAINE
Last Name:STEWART
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8939 VILLA LA JOLLA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1732
Mailing Address - Country:US
Mailing Address - Phone:858-534-9440
Mailing Address - Fax:
Practice Address - Street 1:8939 VILLA LA JOLLA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1732
Practice Address - Country:US
Practice Address - Phone:858-534-9440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other