Provider Demographics
NPI:1720093123
Name:TOTON, JACQUELYN L (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:L
Last Name:TOTON
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 1:12150 GOLD STRIKE RD
Mailing Address - Street 2:
Mailing Address - City:PINE GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95665-9766
Mailing Address - Country:US
Mailing Address - Phone:209-296-2382
Mailing Address - Fax:
Practice Address - Street 1:4021 S 700 E
Practice Address - Street 2:SUITE 300
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-2192
Practice Address - Country:US
Practice Address - Phone:800-328-3067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22870207V00000X
HI12880207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG228701Medicaid
CAA41751Medicare UPIN
CAG228701Medicaid