Healthcare Provider Details

I. General information

NPI: 1962884015
Provider Name (Legal Business Name): JENESSA HILL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 S 7TH AVE
PHOENIX AZ
85007
US

IV. Provider business mailing address

4459 E JOJOBA RD
PHOENIX AZ
85044-1900
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-6600
  • Fax:
Mailing address:
  • Phone: 602-369-8903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0116028550
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number007694
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: