Provider Demographics
NPI:1255760781
Name:JENKINS, CATHLEEN ELIZABETH (LAC)
Entity type:Individual
Prefix:MS
First Name:CATHLEEN
Middle Name:ELIZABETH
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:CATHLEEN
Other - Middle Name:ELIZABETH
Other - Last Name:SYLVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3971 HUBERT AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008
Mailing Address - Country:US
Mailing Address - Phone:323-401-0311
Mailing Address - Fax:
Practice Address - Street 1:1334 WESTWOOD BLVD
Practice Address - Street 2:#5
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4951
Practice Address - Country:US
Practice Address - Phone:323-401-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA(AC)156.10171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist