Provider Demographics
NPI:1700421633
Name:KNOX, JENNIFER (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KNOX
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2356 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-5055
Mailing Address - Country:US
Mailing Address - Phone:805-577-0373
Mailing Address - Fax:
Practice Address - Street 1:2356 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-5055
Practice Address - Country:US
Practice Address - Phone:805-577-0373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management