Provider Demographics
NPI:1851329049
Name:MAO, JENNIFER T (OD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:T
Last Name:MAO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41584 MARGARITA RD
Mailing Address - Street 2:APT 280
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-1847
Mailing Address - Country:US
Mailing Address - Phone:619-414-8986
Mailing Address - Fax:
Practice Address - Street 1:27580 YNEZ RD
Practice Address - Street 2:SUITE A
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4667
Practice Address - Country:US
Practice Address - Phone:951-676-1955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12838T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist