Provider Demographics
NPI:1922178573
Name:MULLER, JENNY H (MD)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:H
Last Name:MULLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:MESHEKOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11030 SANTA MONICA BLVD.
Mailing Address - Street 2:SUITE #107
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7553
Mailing Address - Country:US
Mailing Address - Phone:310-575-0300
Mailing Address - Fax:310-575-0307
Practice Address - Street 1:11030 SANTA MONICA BLVD.
Practice Address - Street 2:SUITE #107
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7553
Practice Address - Country:US
Practice Address - Phone:310-575-0300
Practice Address - Fax:310-575-0307
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA440952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E66674Medicare UPIN