Provider Demographics
NPI:1821033788
Name:SARAYBA, JENNIFER G (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:G
Last Name:SARAYBA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:72780 COUNTRY CLUB DR
Mailing Address - Street 2:BLDG B 205-A
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4126
Mailing Address - Country:US
Mailing Address - Phone:760-779-1721
Mailing Address - Fax:
Practice Address - Street 1:72780 COUNTRY CLUB DR
Practice Address - Street 2:BLDG B 205-A
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4126
Practice Address - Country:US
Practice Address - Phone:760-779-1721
Practice Address - Fax:760-834-3578
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2016-03-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036115473207Q00000X
CAA106726207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036115473OtherIL STATE LIC