Provider Demographics
NPI:1700282779
Name:ACILO, JENNIFER HERNANDEZ (LVN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HERNANDEZ
Last Name:ACILO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 TUMBLEWEED DR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93905-4477
Mailing Address - Country:US
Mailing Address - Phone:831-224-0383
Mailing Address - Fax:
Practice Address - Street 1:822 TUMBLEWEED DR
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93905-4477
Practice Address - Country:US
Practice Address - Phone:831-224-0383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA271430164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse