Provider Demographics
NPI:1831160019
Name:NAMAZY, JENNIFER A (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
Last Name:NAMAZY
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 1:10790 RANCHO BERNARDO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:619-245-2900
Mailing Address - Fax:
Practice Address - Street 1:7565 MISSION VALLEY RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4431
Practice Address - Country:US
Practice Address - Phone:619-245-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74328207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A743280OtherBLUE SHIELD OF CA
P00066581OtherRAILROAD MEDICARE
F833OtherCHAMPUS
CA00A743280Medicaid
00A743280OtherBLUE SHIELD OF CA
CA00A743280Medicaid