Healthcare Provider Details

I. General information

NPI: 1174082234
Provider Name (Legal Business Name): JENNIFER DORAN ROCKSTROM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ALYSE DORAN

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR # 8829
SAN DIEGO CA
92103-1911
US

IV. Provider business mailing address

200 W ARBOR DR # 8829
SAN DIEGO CA
92103-1911
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-8254
  • Fax: 619-543-2990
Mailing address:
  • Phone: 619-543-8254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number5181811
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR.0068775
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA190255
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA190255
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: