Provider Demographics
NPI:1346556297
Name:AULT, JANEL RENEE
Entity type:Individual
Prefix:
First Name:JANEL
Middle Name:RENEE
Last Name:AULT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S PARK AVE STE 750
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-1553
Mailing Address - Country:US
Mailing Address - Phone:909-830-7313
Mailing Address - Fax:
Practice Address - Street 1:2200 E ROUTE 66
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-2005
Practice Address - Country:US
Practice Address - Phone:626-859-2089
Practice Address - Fax:626-859-6537
Is Sole Proprietor?:No
Enumeration Date:2010-08-28
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
CA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner