Provider Demographics
NPI:1750895629
Name:ESTEVEZ, JENNY GISELA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:GISELA
Last Name:ESTEVEZ
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 W. BASELINE RD
Mailing Address - Street 2:BOX 400
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750
Mailing Address - Country:US
Mailing Address - Phone:909-833-2986
Mailing Address - Fax:
Practice Address - Street 1:233 W. BASELINE RD
Practice Address - Street 2:BOX 400
Practice Address - City:LAVERNE
Practice Address - State:CA
Practice Address - Zip Code:91750
Practice Address - Country:US
Practice Address - Phone:909-833-2986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA610091163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health