Provider Demographics
NPI:1689957896
Name:JENKINS, LUISA M (RDH)
Entity Type:Individual
Prefix:MRS
First Name:LUISA
Middle Name:M
Last Name:JENKINS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45074 10TH ST W
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2371
Mailing Address - Country:US
Mailing Address - Phone:661-940-7000
Mailing Address - Fax:
Practice Address - Street 1:2151 E PALMDALE BLVD
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4037
Practice Address - Country:US
Practice Address - Phone:661-575-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14984124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14984OtherREGISTERED DENTAL HYGIENIST