Provider Demographics
NPI:1699200279
Name:ANILES, JENNIFER (BA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ANILES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S FREMONT AVE UNIT 60
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-8886
Mailing Address - Country:US
Mailing Address - Phone:626-607-6995
Mailing Address - Fax:
Practice Address - Street 1:1000 S FREMONT AVE UNIT 60
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-8886
Practice Address - Country:US
Practice Address - Phone:626-607-6995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst