Provider Demographics
NPI:1164255337
Name:URENO, JENNIFER GARCIA
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GARCIA
Last Name:URENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 N GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-3420
Mailing Address - Country:US
Mailing Address - Phone:661-433-5153
Mailing Address - Fax:
Practice Address - Street 1:924 N GARDEN ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-3420
Practice Address - Country:US
Practice Address - Phone:661-433-5153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86358738133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered