Healthcare Provider Details

I. General information

NPI: 1285604702
Provider Name (Legal Business Name): ENCHANTA L JENKINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

577 E ELDER ST STE F
FALLBROOK CA
92028-3079
US

IV. Provider business mailing address

1374 S MISSION RD UNIT 429
FALLBROOK CA
92028-4006
US

V. Phone/Fax

Practice location:
  • Phone: 760-645-3407
  • Fax: 760-990-4523
Mailing address:
  • Phone: 760-909-9435
  • Fax: 760-990-4523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC143625
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number200301268
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number200301268
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number200301268
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01053687A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: