Healthcare Provider Details

I. General information

NPI: 1598916637
Provider Name (Legal Business Name): JENNIFER MICHELLE PRINCE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CASTRO ST SUITE 121
SAN FRANCISCO CA
94114-1010
US

IV. Provider business mailing address

45 CASTRO ST SUITE 121
SAN FRANCISCO CA
94114-1010
US

V. Phone/Fax

Practice location:
  • Phone: 415-565-6897
  • Fax: 415-864-1654
Mailing address:
  • Phone: 415-565-6897
  • Fax: 415-864-1654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA105084
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: