Provider Demographics
NPI:1891027587
Name:ANDERSON, JENNA RYAN (CD(DONA))
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:RYAN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 RUBENSTEIN AVE
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-2428
Mailing Address - Country:US
Mailing Address - Phone:760-809-2551
Mailing Address - Fax:
Practice Address - Street 1:1428 RUBENSTEIN AVE
Practice Address - Street 2:
Practice Address - City:CARDIFF
Practice Address - State:CA
Practice Address - Zip Code:92007-2428
Practice Address - Country:US
Practice Address - Phone:760-809-2551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula