Provider Demographics
NPI:1558577403
Name:FARRELL, JENNIFER LOVE (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LOVE
Last Name:FARRELL
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 1:3150 BRISTOL ST STE 400
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3054
Mailing Address - Country:US
Mailing Address - Phone:949-266-3700
Mailing Address - Fax:
Practice Address - Street 1:3150 BRISTOL ST STE 400
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3054
Practice Address - Country:US
Practice Address - Phone:949-266-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMDR-44092084P0800X
CAA1045212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty