Basic Information
| Provider Information | |||||||||
| NPI: | 1003230939 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JENKINS | ||||||||
| FirstName: | DANIEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 FOREST RIDGE RD UNIT 6 | ||||||||
| Address2: | |||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939404129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102211827 | ||||||||
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| Practice Location | |||||||||
| Address1: | 81 SOLEDAD DR | ||||||||
| Address2: | |||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939406037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003532008 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2014 | ||||||||
| LastUpdateDate: | 08/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 376G00000X | 8012 | CA | Y | Nursing Service Related Providers | Nursing Home Administrator |
No ID Information.