Provider Demographics
NPI:1730892852
Name:VEST, JENNY MARIE
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:MARIE
Last Name:VEST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:MARIE
Other - Last Name:TRUJILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10751 DALE AVE
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-2604
Mailing Address - Country:US
Mailing Address - Phone:714-821-5311
Mailing Address - Fax:714-821-6302
Practice Address - Street 1:10751 DALE AVE
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-2604
Practice Address - Country:US
Practice Address - Phone:714-821-5311
Practice Address - Fax:714-821-6302
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA698975164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse