Provider Demographics
NPI:1518662741
Name:DIBERNARDO, JENNA CHRISTINE (LACTATION COUNSELOR)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:CHRISTINE
Last Name:DIBERNARDO
Suffix:
Gender:F
Credentials:LACTATION COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25809 MARGUERITE PKWY APT 101
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-3108
Mailing Address - Country:US
Mailing Address - Phone:949-680-0921
Mailing Address - Fax:
Practice Address - Street 1:25809 MARGUERITE PKWY APT 101
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-3108
Practice Address - Country:US
Practice Address - Phone:949-680-0921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN