Provider Demographics
NPI:1477699122
Name:SWINEY, JENNIFER ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ROSE
Last Name:SWINEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 7TH ST
Mailing Address - Street 2:#9
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2615
Mailing Address - Country:US
Mailing Address - Phone:310-428-5938
Mailing Address - Fax:
Practice Address - Street 1:5 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-1448
Practice Address - Country:US
Practice Address - Phone:605-698-7606
Practice Address - Fax:605-698-4270
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85750174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB18480Medicare UPIN
CA341000168Medicare ID - Type Unspecified