Provider Demographics
NPI:1891300430
Name:LENDARIS, JENNIFER (NBC-HWC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LENDARIS
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2584 STIRLING CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5064
Mailing Address - Country:US
Mailing Address - Phone:925-330-0029
Mailing Address - Fax:
Practice Address - Street 1:2584 STIRLING CT
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5064
Practice Address - Country:US
Practice Address - Phone:925-330-0029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174H00000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator