Provider Demographics
NPI:1144223793
Name:JENSEN, STEVE CHRISTIAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:CHRISTIAN
Last Name:JENSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 DELNERO DR
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5223
Mailing Address - Country:US
Mailing Address - Phone:209-533-2468
Mailing Address - Fax:209-533-1722
Practice Address - Street 1:780 DELNERO DR
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5223
Practice Address - Country:US
Practice Address - Phone:209-533-2468
Practice Address - Fax:209-533-1722
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2016-09-08
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
CAE2833213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E28330Medicaid
T11489Medicare UPIN
CA0838240001Medicare NSC
CA0838240001Medicare NSC