Healthcare Provider Details

I. General information

NPI: 1447664628
Provider Name (Legal Business Name): JARED ROSS RISPENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 UNION ST APT 2003
SAN DIEGO CA
92101-3638
US

IV. Provider business mailing address

1401 UNION ST APT 2003
SAN DIEGO CA
92101-3638
US

V. Phone/Fax

Practice location:
  • Phone: 619-786-7383
  • Fax: 858-742-8323
Mailing address:
  • Phone: 619-786-7383
  • Fax: 858-742-8323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125-064636
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125-064636
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: