Provider Demographics
NPI:1588993059
Name:CLEBANOFF, JENNIFER LYNNE (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNNE
Last Name:CLEBANOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UCLA PATHOLOGY AND LABORATORY MEDICINE
Mailing Address - Street 2:BOX 951732, A7-149 CHS
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1732
Mailing Address - Country:US
Mailing Address - Phone:310-825-5719
Mailing Address - Fax:
Practice Address - Street 1:UCLA PATHOLOGY AND LABORATORY MEDICINE
Practice Address - Street 2:BOX 951732, A7-149 CHS
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1732
Practice Address - Country:US
Practice Address - Phone:310-825-5719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-13
Last Update Date:2009-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA103194207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology