Provider Demographics
NPI:1043480965
Name:OVERSTREET, JENNIFER MARIE JONES (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIE JONES
Last Name:OVERSTREET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:471 OLD NEWPORT BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4244
Mailing Address - Country:US
Mailing Address - Phone:949-645-3534
Mailing Address - Fax:
Practice Address - Street 1:ONE HOAG DRIVE
Practice Address - Street 2:HOAG MEMORIAL HOSPITAL PRESBYTERIAN
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92658
Practice Address - Country:US
Practice Address - Phone:949-645-3534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA906942085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A906840Medicaid
CA00A906840Medicaid
CAWA90694BMedicare PIN