Provider Demographics
NPI:1295703775
Name:BRIMMER, JENNA JOELLE (MD)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:JOELLE
Last Name:BRIMMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:BEECH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:501 S SHORE CTR W
Mailing Address - Street 2:SUITE 103F
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5762
Mailing Address - Country:US
Mailing Address - Phone:530-814-4630
Mailing Address - Fax:530-814-4644
Practice Address - Street 1:501 S SHORE CTR W
Practice Address - Street 2:SUITE 103F
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5762
Practice Address - Country:US
Practice Address - Phone:530-814-4630
Practice Address - Fax:530-814-4644
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81625207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A816250Medicare ID - Type Unspecified
I25670Medicare UPIN