Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 21983 | CA |
N | 363LG0600X | Nurse Practitioner - Gerontology | 21983 | CA |
NPI | 1023429909 |
---|---|
Provider Name | Davy Jenkins |
First Address | San Diego, CA 92134-1098 |
Second Address | San Diego, CA 92134-1098 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2014 |
Last Update Date | 14/05/2014 |