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NPI Code Detail

MEDICARE: JENNIFER J IP PA-C

MEDICARE:   JENNIFER J IP  PA-C
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
1363A00000XPhysician AssistantPA65170CA
2363A00000XPhysician Assistant

General Provider Information

NPI Number : 1154157188
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER J IP PA-C
Provider Business Mailing Address
First Line : 28212 KELLY JOHNSON PKWY STE 245
Second Line :
City : VALENCIA
State : CA
Zip : 91355-5092
Country : US
Telephone Number : 661-254-3686
Fax Number : 661-254-5671
Provider Business Practice Location Address
First Line : 4100 EMPIRE DR STE 120140
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93309-0410
Country : US
Telephone Number : 866-903-3376
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2024
Last Update Date : 01/19/2026

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Directions to “ JENNIFER J IP PA-C” Practice Location

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