Provider Demographics
NPI:1649210261
Name:JENSEN, MAUREEN C (MD)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:C
Last Name:JENSEN
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:PO BOX 3095
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-0659
Mailing Address - Country:US
Mailing Address - Phone:949-764-5570
Mailing Address - Fax:949-263-0473
Practice Address - Street 1:ONE HOAG DRIVE
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4162
Practice Address - Country:US
Practice Address - Phone:949-764-5570
Practice Address - Fax:949-263-0473
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG614942085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G614940OtherBLUE SHIELD
CA00G614940Medicaid
F72824Medicare UPIN
CA00G614940OtherBLUE SHIELD