Provider Demographics
NPI:1497374292
Name:HEATH, JENNA MAURER (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:MAURER
Last Name:HEATH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:JENNA
Other - Middle Name:MAURER
Other - Last Name:HERSKIND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:831 N HUMPHREYS AVE
Mailing Address - Street 2:
Mailing Address - City:EAST LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-1036
Mailing Address - Country:US
Mailing Address - Phone:716-359-0646
Mailing Address - Fax:
Practice Address - Street 1:2050 MARENGO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1353
Practice Address - Country:US
Practice Address - Phone:716-359-0646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-11
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program