Provider Demographics
NPI:1720233463
Name:JENICE STANIFORD
Entity Type:Organization
Organization Name:JENICE STANIFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JENICE
Authorized Official - Middle Name:LORENA
Authorized Official - Last Name:STANIFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:619-286-0677
Mailing Address - Street 1:4626 59TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-3830
Mailing Address - Country:US
Mailing Address - Phone:619-286-0677
Mailing Address - Fax:
Practice Address - Street 1:4626 59TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-3830
Practice Address - Country:US
Practice Address - Phone:619-286-0677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMLO21394305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service