Provider Demographics
NPI:1114362894
Name:TIMBOE, JENNA K (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:K
Last Name:TIMBOE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:505 S MAIN ST
Mailing Address - Street 2:SUITE 525
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4509
Mailing Address - Country:US
Mailing Address - Phone:714-456-5631
Mailing Address - Fax:714-285-0389
Practice Address - Street 1:1300 AVENIDA VISTA HERMOSA STE 200
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6338
Practice Address - Country:US
Practice Address - Phone:949-429-7700
Practice Address - Fax:949-429-7704
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2019-07-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA134953208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1114362894Medicaid