Provider Demographics
NPI:1841450731
Name:FAVREAU, JESSICA BARRY (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:BARRY
Last Name:FAVREAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:BARRY
Other - Last Name:EICHINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 1ST ST STE 15
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-2756
Mailing Address - Country:US
Mailing Address - Phone:650-668-2558
Mailing Address - Fax:
Practice Address - Street 1:1 1ST ST STE 15
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-2756
Practice Address - Country:US
Practice Address - Phone:650-668-2558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA139150207R00000X
CA139150207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine