Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | A117230 | CA |
N | 208000000X | Pediatrician | A117230 | CA |
NPI | 1033464821 |
---|---|
Provider Name | Jessica Tenney |
First Address | West Hollywood, CA 90048-1804 |
Second Address | West Hollywood, CA 90048-1804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2012 |
Last Update Date | 17/07/2012 |