Healthcare Provider Details

I. General information

NPI: 1407977358
Provider Name (Legal Business Name): JEANNETTE A DOOLITTLE MMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559B SO. STATE HIGHWAY 49
JACKSON CA
95642-2524
US

IV. Provider business mailing address

559 S HIGHWAY 49 STE B
JACKSON CA
95642-2524
US

V. Phone/Fax

Practice location:
  • Phone: 209-256-3380
  • Fax: 209-223-4777
Mailing address:
  • Phone: 209-256-3380
  • Fax: 209-223-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: