Provider Demographics
NPI:1528578192
Name:JENKINS, AUTYM
Entity Type:Individual
Prefix:
First Name:AUTYM
Middle Name:
Last Name:JENKINS
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 1:505 N BRAND BLVD STE 1000
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-3924
Mailing Address - Country:US
Mailing Address - Phone:855-295-3276
Mailing Address - Fax:818-241-6823
Practice Address - Street 1:9900 MONTANA AVE STE C6
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-1534
Practice Address - Country:US
Practice Address - Phone:855-295-3276
Practice Address - Fax:818-241-6823
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician