Provider Demographics
NPI:1780087544
Name:KLENOV, JILL N (RPT)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:N
Last Name:KLENOV
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11781 DAVENPORT RD
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-4308
Mailing Address - Country:US
Mailing Address - Phone:562-795-0345
Mailing Address - Fax:
Practice Address - Street 1:11781 DAVENPORT RD
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-4308
Practice Address - Country:US
Practice Address - Phone:562-795-0345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16086225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist