Basic Information
| Provider Information | |||||||||
| NPI: | 1922197953 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JENKINS | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | JENE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 ROSSI CIR | ||||||||
| Address2: | SUITE 141 | ||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939072362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317574444 | ||||||||
| FaxNumber: | 8317574419 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 NEILSON ST | ||||||||
| Address2: | STE 1432 | ||||||||
| City: | WATSONVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950762468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317636088 | ||||||||
| FaxNumber: | 8317636463 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 12/30/2009 | ||||||||
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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 | 207Q00000X | A26750 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | A26750 | CA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.