Provider Demographics
NPI:1508044983
Name:STEVE C. JENSEN, DPM, INC
Entity Type:Organization
Organization Name:STEVE C. JENSEN, DPM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:209-533-2468
Mailing Address - Street 1:780 DELNERO DR
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5223
Mailing Address - Country:US
Mailing Address - Phone:209-533-2468
Mailing Address - Fax:209-533-1722
Practice Address - Street 1:780 DELNERO DR
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5223
Practice Address - Country:US
Practice Address - Phone:209-533-2468
Practice Address - Fax:209-533-1722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2833332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0838240001Medicare NSC