Provider Demographics
NPI:1598916637
Name:PRINCE, JENNIFER MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:PRINCE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:45 CASTRO ST
Mailing Address - Street 2:SUITE 121
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1010
Mailing Address - Country:US
Mailing Address - Phone:415-565-6897
Mailing Address - Fax:415-864-1654
Practice Address - Street 1:45 CASTRO ST
Practice Address - Street 2:SUITE 121
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1010
Practice Address - Country:US
Practice Address - Phone:415-565-6897
Practice Address - Fax:415-864-1654
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA105084208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA105084OtherMEDICAL LICENSE
CAFP1084095OtherDEA