Provider Demographics
NPI:1275513558
Name:MURPHY, JENNIFER B (RPT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:B
Last Name:MURPHY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:B
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:2505 CABRILLO COLLEGE DR
Mailing Address - Street 2:C
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3166
Mailing Address - Country:US
Mailing Address - Phone:831-464-3901
Mailing Address - Fax:831-464-3010
Practice Address - Street 1:2505 CABRILLO COLLEGE DR
Practice Address - Street 2:C
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3166
Practice Address - Country:US
Practice Address - Phone:831-464-3901
Practice Address - Fax:831-464-3010
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25403174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ19929ZMedicare ID - Type Unspecified