Provider Demographics
NPI:1710204821
Name:GIRARD, JENELLE MARIE (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MS
First Name:JENELLE
Middle Name:MARIE
Last Name:GIRARD
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 ABBOT KINNEY BLVD
Mailing Address - Street 2:#204
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-5505
Mailing Address - Country:US
Mailing Address - Phone:323-491-6200
Mailing Address - Fax:
Practice Address - Street 1:2724 ABBOT KINNEY BLVD
Practice Address - Street 2:#204
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-5505
Practice Address - Country:US
Practice Address - Phone:323-491-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program