Provider Demographics
NPI:1518576065
Name:CHANDRA, JENI RADHIKA
Entity Type:Individual
Prefix:MRS
First Name:JENI
Middle Name:RADHIKA
Last Name:CHANDRA
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 1:110 BAILEY RD
Mailing Address - Street 2:
Mailing Address - City:BAY POINT
Mailing Address - State:CA
Mailing Address - Zip Code:94565-6620
Mailing Address - Country:US
Mailing Address - Phone:925-510-3542
Mailing Address - Fax:
Practice Address - Street 1:110 BAILEY RD
Practice Address - Street 2:
Practice Address - City:BAY POINT
Practice Address - State:CA
Practice Address - Zip Code:94565-6620
Practice Address - Country:US
Practice Address - Phone:925-510-3542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician