Healthcare Provider Details

I. General information

NPI: 1366408569
Provider Name (Legal Business Name): JACQUELINE G PARTHEMORE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MRS. JACQUELINE P BLANK

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 LA JOLLA VILLAGE DR
SAN DIEGO CA
92161-0002
US

IV. Provider business mailing address

PO BOX 2434 6416 EL SICOMORO
RANCHO SANTA FE CA
92067-2434
US

V. Phone/Fax

Practice location:
  • Phone: 858-552-7419
  • Fax: 858-552-7420
Mailing address:
  • Phone: 858-756-2917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberG016942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: