Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | MD60218218 | WA |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | MD60218218 | WA |
NPI | 1235313867 |
---|---|
Provider Name | Dr. Jennifer A Jolley |
First Address | Orange, CA 92868-5900 |
Second Address | Orange, CA 92868 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2007 |
Last Update Date | 07/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0279991 | L&I (01) | WA |
1235313867 | (05) | WA |