Provider Demographics
NPI:1629268917
Name:DAGANZO, JENIFER V (AUD)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:V
Last Name:DAGANZO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 BUCKINGHAM WAY
Mailing Address - Street 2:SUITE 437
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1909
Mailing Address - Country:US
Mailing Address - Phone:415-759-8851
Mailing Address - Fax:415-759-8873
Practice Address - Street 1:595 BUCKINGHAM WAY
Practice Address - Street 2:SUITE 437
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1909
Practice Address - Country:US
Practice Address - Phone:415-759-8851
Practice Address - Fax:415-759-8873
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 1874237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS94485Medicare UPIN
CAZZZ32801ZMedicare PIN