Provider Demographics
NPI:1306039755
Name:TIMMONS, JENNIFER MALIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MALIN
Last Name:TIMMONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ASHUNNIA
Other - Last Name:MALIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:510 N PROSPECT AVE
Mailing Address - Street 2:SUITE # 304
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3030
Mailing Address - Country:US
Mailing Address - Phone:310-372-8005
Mailing Address - Fax:310-376-0793
Practice Address - Street 1:510 N PROSPECT AVE
Practice Address - Street 2:SUITE # 304
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3030
Practice Address - Country:US
Practice Address - Phone:310-372-8005
Practice Address - Fax:310-376-0793
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106587207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1306039755Medicaid
CAA106587OtherMEDICAL BOARD OF CALIFORNIA
CADY679YMedicare PIN