Provider Demographics
NPI:1629608906
Name:KAHAU-SEGOVIA, JENNIFER MOANI (FNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MOANI
Last Name:KAHAU-SEGOVIA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S FAIR OAKS AVE STE 405
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2562
Mailing Address - Country:US
Mailing Address - Phone:626-440-7325
Mailing Address - Fax:
Practice Address - Street 1:301 S FAIR OAKS AVE STE 405
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2562
Practice Address - Country:US
Practice Address - Phone:626-440-7325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-25
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF10191161363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherDO NOT HAVE AT THIS TIME