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NPI Code Detail

MEDICARE: JEAN GAIL MULLENAX MD

MEDICARE: JEAN GAIL MULLENAX MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianG66967CA

General Provider Information

NPI Number : 1053377671
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEAN GAIL MULLENAX MD
Provider Business Mailing Address
First Line : 4305 UNIVERSITY AVE
Second Line : STE 150
City : SAN DIEGO
State : CA
Zip : 92105-1601
Country : US
Telephone Number : 619-563-0507
Fax Number : 619-563-0015
Provider Business Practice Location Address
First Line : 4058 WILLOWS RD
Second Line :
City : ALPINE
State : CA
Zip : 91901-1668
Country : US
Telephone Number : 619-445-1188
Fax Number : 619-659-3140
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2006
Last Update Date : 01/12/2012

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Directions to “ JEAN GAIL MULLENAX MD” Practice Location

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