Provider Demographics
NPI:1669781191
Name:JENSEN, JACQUELINE (ACUPUNCTURIST)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N SCREENLAND DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-3871
Mailing Address - Country:US
Mailing Address - Phone:310-986-4550
Mailing Address - Fax:
Practice Address - Street 1:333 N SCREENLAND DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-3871
Practice Address - Country:US
Practice Address - Phone:310-986-4550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 13307171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist