Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 823401 | CA |
NPI | 1184291403 |
---|---|
Provider Name | Denise Jensen |
First Address | Irvine, CA 92618-3734 |
Second Address | Irvine, CA 92618-3734 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2021 |
Last Update Date | 06/06/2021 |