Provider Demographics
NPI:1407300940
Name:JENKINS, JULIET ALEXA LIBERTY (MB CHB)
Entity Type:Individual
Prefix:DR
First Name:JULIET
Middle Name:ALEXA LIBERTY
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MB CHB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 COLA BALLENA
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-3608
Mailing Address - Country:US
Mailing Address - Phone:510-316-4031
Mailing Address - Fax:
Practice Address - Street 1:2324 SACRAMENTO ST STE 150
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2383
Practice Address - Country:US
Practice Address - Phone:415-673-5184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-13
Last Update Date:2016-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1444372084N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine