Provider Demographics
NPI:1629410584
Name:CIPA-TATUM, JILLIAN E (DO)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:E
Last Name:CIPA-TATUM
Suffix:
Gender:F
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:2070 CLINTON AVE
Mailing Address - Street 2:ALAMEDA INPATIENT MEDICINE- ALAMEDA HOSPITAL
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4399
Mailing Address - Country:US
Mailing Address - Phone:510-814-4397
Mailing Address - Fax:510-814-4391
Practice Address - Street 1:2070 CLINTON AVE
Practice Address - Street 2:ALAMEDA INPATIENT MEDICINE- ALAMEDA HOSPITAL
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4399
Practice Address - Country:US
Practice Address - Phone:510-814-4397
Practice Address - Fax:510-814-4391
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-20
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A12882207R00000X, 282E00000X, 282N00000X, 283Q00000X, 313M00000X, 314000000X, 320700000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No282E00000XHospitalsLong Term Care HospitalGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty
No283Q00000XHospitalsPsychiatric Hospital
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care FacilityGroup - Single Specialty
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical DisabilitiesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A12882OtherOSTEOPATHIC MEDICAL BOARD LICENSE NUMBER