Most Relevant Information
Provider Data
| NPI Number: | 1003370586 |
| Provider Name: | JENNIFER FERNANDA VALLECILLO |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 01/29/2019 |
| Last Updated: | 08/09/2022 |
Provider Practice Location
566 S BRAND BLVD
SAN FERNANDO
CA
913404002
Practice Location Phone/Fax
| Phone: | 8188980223 |
| Fax: |
Provider Mailing Location
24425 WOOLSEY CANYON RD SPC 106
CANOGA PARK
CA
913046928
Provider Mailing Phone/Fax
| Phone: | 8183313816 |
| Fax: |