Provider Demographics
NPI:1528348109
Name:GONCALVES, JENNA MARIE (BA)
Entity type:Individual
Prefix:MISS
First Name:JENNA
Middle Name:MARIE
Last Name:GONCALVES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5707
Mailing Address - Country:US
Mailing Address - Phone:619-433-5856
Mailing Address - Fax:
Practice Address - Street 1:637 3RD AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5707
Practice Address - Country:US
Practice Address - Phone:619-433-5856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker