Provider Demographics
NPI:1831318229
Name:ANDERSON, JENNIFER LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:HAMILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1400 EAST PAOMAR STREET
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1800
Mailing Address - Country:US
Mailing Address - Phone:858-499-2702
Mailing Address - Fax:619-397-3378
Practice Address - Street 1:1400 EAST PAOMAR STREET
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-1800
Practice Address - Country:US
Practice Address - Phone:858-499-2702
Practice Address - Fax:619-397-3378
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55027207V00000X
MI4301082162207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1831318229OtherNPI