Provider Demographics
NPI:1457854770
Name:MIKHAIL, JENNIFER DANIELLE (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:DANIELLE
Last Name:MIKHAIL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 VIA ALICIA
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93108-1746
Mailing Address - Country:US
Mailing Address - Phone:805-708-9772
Mailing Address - Fax:
Practice Address - Street 1:79200 CORPORATE CENTER DR STE 201
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-7245
Practice Address - Country:US
Practice Address - Phone:760-564-7900
Practice Address - Fax:760-327-7905
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A20103207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology