Provider Demographics
NPI:1619050119
Name:ENGSTROM, JENNIFER E (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:E
Last Name:ENGSTROM
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 1:400 N TUSTIN AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3813
Mailing Address - Country:US
Mailing Address - Phone:949-417-1825
Mailing Address - Fax:949-417-1803
Practice Address - Street 1:400 N TUSTIN AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3813
Practice Address - Country:US
Practice Address - Phone:949-417-1825
Practice Address - Fax:949-417-1803
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85755207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology