Healthcare Provider Details

I. General information

NPI: 1144252560
Provider Name (Legal Business Name): GREGORY JENKINS, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24355 LYONS AVE SUITE 130
NEWHALL CA
91321-2300
US

IV. Provider business mailing address

24355 LYONS AVE SUITE 130
NEWHALL CA
91321-2300
US

V. Phone/Fax

Practice location:
  • Phone: 661-255-9355
  • Fax: 661-255-7591
Mailing address:
  • Phone: 661-255-9355
  • Fax: 661-255-7591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. GREGORY D JENKINS
Title or Position: OWNER
Credential: M.D.
Phone: 661-255-9355