Provider Demographics
NPI:1396032363
Name:ETEMAD, JACQUELINE GREY (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:GREY
Last Name:ETEMAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:15 VENADO DR
Mailing Address - Street 2:
Mailing Address - City:TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920-1634
Mailing Address - Country:US
Mailing Address - Phone:415-435-2776
Mailing Address - Fax:415-435-9415
Practice Address - Street 1:15 VENADO DR
Practice Address - Street 2:
Practice Address - City:TIBURON
Practice Address - State:CA
Practice Address - Zip Code:94920-1634
Practice Address - Country:US
Practice Address - Phone:415-435-2776
Practice Address - Fax:415-435-9415
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA217462084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry