Provider Demographics
NPI:1780719799
Name:ABENOJAR, JIMMARK V (MD)
Entity type:Individual
Prefix:
First Name:JIMMARK
Middle Name:V
Last Name:ABENOJAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:129 C ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4588
Mailing Address - Country:US
Mailing Address - Phone:530-643-7546
Mailing Address - Fax:888-782-0169
Practice Address - Street 1:129 C ST
Practice Address - Street 2:SUITE 5
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4588
Practice Address - Country:US
Practice Address - Phone:530-643-7546
Practice Address - Fax:888-782-0169
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA973512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry