Basic Information
| Provider Information | |||||||||
| NPI: | 1134209927 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HORCH | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6090 REDWOOD BLVD G | ||||||||
| Address2: | |||||||||
| City: | NOVATO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949454569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4157983106 | ||||||||
| FaxNumber: | 4157983180 | ||||||||
| Practice Location | |||||||||
| Address1: | 12304 SANTA MONICA BLVD | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900252551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3108208084 | ||||||||
| FaxNumber: | 3108205738 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 08/05/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 1580 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | RN540714 | 01 | CA | MEDI-CAL | OTHER |