Provider Demographics
NPI:1831222322
Name:PAINOVICH, JEANNETTE (MA LAC)
Entity type:Individual
Prefix:MISS
First Name:JEANNETTE
Middle Name:
Last Name:PAINOVICH
Suffix:
Gender:F
Credentials:MA LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1358
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-8358
Mailing Address - Country:US
Mailing Address - Phone:562-431-4120
Mailing Address - Fax:562-431-7278
Practice Address - Street 1:5242 KATELLA AVE STE 106
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2863
Practice Address - Country:US
Practice Address - Phone:562-431-4120
Practice Address - Fax:562-431-7278
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7380171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist