Provider Demographics
NPI:1174634356
Name:MATTOX, JENNIFER SOLOMON (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SOLOMON
Last Name:MATTOX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KAISER PERMANENTE NOVATO MEDICAL OFFICES
Mailing Address - Street 2:97 SAN MARIN DR.
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945
Mailing Address - Country:US
Mailing Address - Phone:415-899-7525
Mailing Address - Fax:415-899-7623
Practice Address - Street 1:97 SAN MARIN DR
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-1100
Practice Address - Country:US
Practice Address - Phone:415-899-7525
Practice Address - Fax:415-899-7623
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN- 514466, NP- 9992363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN514466Medicaid
CAP26327/ZZZMedicare UPIN
CARN514466Medicaid