Provider Demographics
NPI:1780827139
Name:IRWIN, JENNIFER BARBARA
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BARBARA
Last Name:IRWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 60TH ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2369
Mailing Address - Country:US
Mailing Address - Phone:510-835-2505
Mailing Address - Fax:510-835-1062
Practice Address - Street 1:954 60TH ST
Practice Address - Street 2:SUITE 10
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-2369
Practice Address - Country:US
Practice Address - Phone:510-835-2505
Practice Address - Fax:510-835-1062
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0136Medicaid