Healthcare Provider Details

I. General information

NPI: 1942648910
Provider Name (Legal Business Name): JENNA MIKO SEUFERT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E EL CAMINO REAL
MOUNTAIN VIEW CA
94040-2833
US

IV. Provider business mailing address

245 N 15TH ST # MS 495
PHILADELPHIA PA
19102-1101
US

V. Phone/Fax

Practice location:
  • Phone: 650-934-7616
  • Fax: 650-934-7655
Mailing address:
  • Phone: 215-762-8220
  • Fax: 215-762-1470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA148632
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: