Provider Demographics
NPI:1699487553
Name:LORAH, JENESSA FRANCINE I
Entity type:Individual
Prefix:MS
First Name:JENESSA
Middle Name:FRANCINE
Last Name:LORAH
Suffix:I
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 1:1441 DETROIT AVE APT 356
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-3526
Mailing Address - Country:US
Mailing Address - Phone:925-276-3860
Mailing Address - Fax:
Practice Address - Street 1:4540 HARLIN DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-9716
Practice Address - Country:US
Practice Address - Phone:916-364-7800
Practice Address - Fax:916-361-9987
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist