Provider Demographics
NPI:1790264083
Name:JAFFA, WENDY NISHIKAWA
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:NISHIKAWA
Last Name:JAFFA
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 1:1527 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2358
Mailing Address - Country:US
Mailing Address - Phone:310-394-9871
Mailing Address - Fax:
Practice Address - Street 1:1527 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2358
Practice Address - Country:US
Practice Address - Phone:310-394-9871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker