Provider Demographics
NPI:1902965825
Name:BOTELHO, JENNIFER CUNHA (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:CUNHA
Last Name:BOTELHO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:BOTELHO
Other - Last Name:CUNHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:322 N LA BREA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-2518
Mailing Address - Country:US
Mailing Address - Phone:323-935-9777
Mailing Address - Fax:
Practice Address - Street 1:322 N LA BREA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-2518
Practice Address - Country:US
Practice Address - Phone:323-935-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25662111N00000X
MA2227111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor