Basic Information
| Provider Information | |||||||||
| NPI: | 1619050119 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENGSTROM | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 N TUSTIN AVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927053813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494171825 | ||||||||
| FaxNumber: | 9494171803 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 N TUSTIN AVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927053813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9494171825 | ||||||||
| FaxNumber: | 9494171803 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 01/27/2011 | ||||||||
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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 | 207L00000X | A85755 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.