Provider Demographics
NPI:1992849491
Name:JENKINS, DANIEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:JENKINS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 CAMINO DEL RIO S
Mailing Address - Street 2:STE 315
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3717
Mailing Address - Country:US
Mailing Address - Phone:619-347-3457
Mailing Address - Fax:619-584-5644
Practice Address - Street 1:4025 CAMINO DEL RIO S STE 250
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4100
Practice Address - Country:US
Practice Address - Phone:619-583-1018
Practice Address - Fax:619-280-5420
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10627103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP10627Medicare ID - Type UnspecifiedMEDICARE