Provider Demographics
NPI:1023144946
Name:FLEFIL-SIMON, JENNIFER MICHELLE (BA)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:FLEFIL-SIMON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:MICHELLE
Other - Last Name:BETANCOURT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:20739 LYCOMING ST SPC 116
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-7416
Mailing Address - Country:US
Mailing Address - Phone:909-569-5447
Mailing Address - Fax:
Practice Address - Street 1:2640 INDUSTRY WAY STE G&H
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-4284
Practice Address - Country:US
Practice Address - Phone:310-631-9763
Practice Address - Fax:310-631-9763
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1023144946172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker