Provider Demographics
NPI:1609959683
Name:ANNUNZIATA, JENNIFER EMILY (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:EMILY
Last Name:ANNUNZIATA
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 1:337 CHENERY ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-3069
Mailing Address - Country:US
Mailing Address - Phone:415-596-8066
Mailing Address - Fax:415-469-7419
Practice Address - Street 1:337 CHENERY ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-3069
Practice Address - Country:US
Practice Address - Phone:415-596-8066
Practice Address - Fax:415-469-7419
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA731652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A731651Medicare ID - Type Unspecified
I36521Medicare UPIN