Healthcare Provider Details

I. General information

NPI: 1942203609
Provider Name (Legal Business Name): DONELLA JENKINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 ALHAMBRA BLVD
SACRAMENTO CA
95817-1110
US

IV. Provider business mailing address

777 12TH ST STE 250
SACRAMENTO CA
95814-1929
US

V. Phone/Fax

Practice location:
  • Phone: 916-313-8400
  • Fax: 916-436-5559
Mailing address:
  • Phone: 916-469-4690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA54017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: