Provider Demographics
NPI:1124737127
Name:SILVA, JENNIFER KRISTEEN
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KRISTEEN
Last Name:SILVA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:KRISTEEN
Other - Last Name:MALONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1341 W ROBINHOOD DR STE B10
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5517
Mailing Address - Country:US
Mailing Address - Phone:209-938-3301
Mailing Address - Fax:
Practice Address - Street 1:1341 W ROBINHOOD DR STE B10
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5517
Practice Address - Country:US
Practice Address - Phone:209-938-3301
Practice Address - Fax:209-938-3301
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No251X00000XAgenciesSupports Brokerage