Provider Demographics
NPI:1457538373
Name:TENA, JAYSON MICHAEL (AA)
Entity Type:Individual
Prefix:
First Name:JAYSON
Middle Name:MICHAEL
Last Name:TENA
Suffix:
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 1/2 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-2517
Mailing Address - Country:US
Mailing Address - Phone:323-351-7950
Mailing Address - Fax:
Practice Address - Street 1:423 1/2 S OAK ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-2517
Practice Address - Country:US
Practice Address - Phone:323-351-7950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator