Provider Demographics
NPI:1962792408
Name:NORTH, JENNIFER SARA (LAC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SARA
Last Name:NORTH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1500 OAK VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1425
Mailing Address - Country:US
Mailing Address - Phone:510-910-3351
Mailing Address - Fax:510-526-5098
Practice Address - Street 1:1500 OAK VIEW AVE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:CA
Practice Address - Zip Code:94706-1425
Practice Address - Country:US
Practice Address - Phone:510-910-3351
Practice Address - Fax:510-526-5098
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 12472171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist