Provider Demographics
NPI:1942203609
Name:JENKINS, DONELLA (MD)
Entity Type:Individual
Prefix:
First Name:DONELLA
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 12TH ST
Mailing Address - Street 2:STE 250
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-1929
Mailing Address - Country:US
Mailing Address - Phone:916-469-4690
Mailing Address - Fax:
Practice Address - Street 1:2425 ALHAMBRA BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1110
Practice Address - Country:US
Practice Address - Phone:916-313-8400
Practice Address - Fax:916-436-5559
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54017207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG77466Medicare UPIN
CA00A540170Medicare ID - Type Unspecified
AQ564PMedicare PIN