Provider Demographics
NPI:1659815496
Name:JOSWICK, JENNIFER C (RE)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:JOSWICK
Suffix:
Gender:F
Credentials:RE
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:J
Other - Last Name:SHERWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RE
Mailing Address - Street 1:5175 MELBOURNE PL
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-6053
Mailing Address - Country:US
Mailing Address - Phone:559-308-5164
Mailing Address - Fax:888-502-7213
Practice Address - Street 1:8615 FLORENCE AVE STE 212
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-4037
Practice Address - Country:US
Practice Address - Phone:559-308-5164
Practice Address - Fax:888-502-7213
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8407174400000X
CARE8407174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1659815496OtherNPI