Provider Demographics
NPI:1780027649
Name:ELLINOY, JESSICA RACHEL (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RACHEL
Last Name:ELLINOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:RACHEL
Other - Last Name:DE STIGTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:582 MARKET ST STE 812
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-5309
Mailing Address - Country:US
Mailing Address - Phone:415-922-9122
Mailing Address - Fax:415-920-9925
Practice Address - Street 1:582 MARKET ST STE 812
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-5309
Practice Address - Country:US
Practice Address - Phone:415-922-9122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1352402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA135240OtherSTATE MEDICAL LICENSE
CAFE5186223OtherFEDERAL DEA LICENSE