Basic Information
| Provider Information | |||||||||
| NPI: | 1730475690 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAMBOR | ||||||||
| FirstName: | NANCY-ANN | ||||||||
| MiddleName: | KEONAONA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.A., RAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2178 JOHNSON AVE | ||||||||
| Address2: | |||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934014535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8052263212 | ||||||||
| FaxNumber: | 8052263221 | ||||||||
| Practice Location | |||||||||
| Address1: | 2178 JOHNSON AVE | ||||||||
| Address2: | |||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8052263212 | ||||||||
| FaxNumber: | 8052263221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2011 | ||||||||
| LastUpdateDate: | 08/03/2018 | ||||||||
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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 | 172V00000X | N | Other Service Providers | Community Health Worker | 106H00000X | 100865 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.