Provider Demographics
NPI:1043546419
Name:ESSEX, JENNIFER J (LAC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:J
Last Name:ESSEX
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:J
Other - Last Name:ESSEX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:117 W SMOKE TREE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-7700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:555 S CHINA LAKE BLVD
Practice Address - Street 2:STE 300
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-5052
Practice Address - Country:US
Practice Address - Phone:760-375-2426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12991171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist