Provider Demographics
NPI:1922197953
Name:JENKINS, LISA JENE (MD)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:JENE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4 ROSSI CIR
Mailing Address - Street 2:SUITE 141
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93907-2362
Mailing Address - Country:US
Mailing Address - Phone:831-757-4444
Mailing Address - Fax:831-757-4419
Practice Address - Street 1:75 NEILSON ST
Practice Address - Street 2:STE 1432
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2468
Practice Address - Country:US
Practice Address - Phone:831-763-6088
Practice Address - Fax:831-763-6463
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA26750207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A267501Medicare PIN
CAA24949Medicare UPIN
CA00A267500Medicare PIN