Provider Demographics
NPI:1578785218
Name:BAARS, JENNIFER LEE (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:BAARS
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 1:855 MANHATTAN BEACH BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-4965
Mailing Address - Country:US
Mailing Address - Phone:310-939-7858
Mailing Address - Fax:
Practice Address - Street 1:855 MANHATTAN BEACH BLVD STE 102
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-4965
Practice Address - Country:US
Practice Address - Phone:310-939-7858
Practice Address - Fax:310-939-7842
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ77354207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics