Jeffensen Jay Timacdog
Nurse Practitioner Nurse Practitioner - Primary Care
2175 Park Pl
El Segundo
, California 90245-4705
Jeffensen Jay Timacdog
Nurse Practitioner Nurse Practitioner - Primary Care
2175 Park Pl
El Segundo
, California 90245-4705
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About
Features
Specialties
- Nurse Practitioner
- Nurse Practitioner - Primary Care
Languages spoken
- English
Location
First Address
- Jeffensen Jay Timacdog
- 1196 3rd Ave
- Chula Vista, CA
- Zip : 91911-3131
- Phone :
Second Address
- Jeffensen Jay Timacdog
- 2175 Park Pl
- El Segundo, CA
- Zip : 90245-4705
- Phone : (818) 337-8701
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Is Jeffensen Jay Timacdog a sole practitioner?
Is Jeffensen Jay Timacdog accepting new patients?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | 95008823 | CA |
| Y | 363LP2300X | Nurse Practitioner - Primary Care | NP95008823 | CA |
National Provider Identifier
| NPI | 1083103956 |
|---|---|
| Provider Name | Jeffensen Jay Timacdog |
| First Address | Chula Vista, CA 91911-3131 |
| Second Address | El Segundo, CA 90245-4705 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 07/05/2018 |
| Last Update Date | 24/02/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.