Provider Demographics
NPI:1932628005
Name:MAINWAL, JODI ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:JODI
Middle Name:ANN
Last Name:MAINWAL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17638 WILDFLOWER PL
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3264
Mailing Address - Country:US
Mailing Address - Phone:951-235-3013
Mailing Address - Fax:
Practice Address - Street 1:11 TECHNOLOGY DR # MS 41
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2302
Practice Address - Country:US
Practice Address - Phone:949-923-3200
Practice Address - Fax:949-923-3520
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA494337163WC0400X, 163WH0500X, 163WN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0300XNursing Service ProvidersRegistered NurseNephrology
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH0500XNursing Service ProvidersRegistered NurseHemodialysis