Provider Demographics
NPI:1639969876
Name:JENKINS, HERTHA
Entity type:Individual
Prefix:
First Name:HERTHA
Middle Name:
Last Name:JENKINS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7667 YELLOW IRIS CT
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-0730
Mailing Address - Country:US
Mailing Address - Phone:909-648-9625
Mailing Address - Fax:
Practice Address - Street 1:7667 YELLOW IRIS CT
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-0730
Practice Address - Country:US
Practice Address - Phone:909-648-9625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health