Provider Demographics
NPI:1164481313
Name:WILKES, JENNIFER BROOKE (DO)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BROOKE
Last Name:WILKES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1594 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-8224
Mailing Address - Country:US
Mailing Address - Phone:760-822-3454
Mailing Address - Fax:
Practice Address - Street 1:38860 SKY CANYON DR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2540
Practice Address - Country:US
Practice Address - Phone:951-696-2215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2022-07-21
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2015-05-28
Provider Licenses
StateLicense IDTaxonomies
CA20A 7448208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice