Healthcare Provider Details

I. General information

NPI: 1730548801
Provider Name (Legal Business Name): MR. PARIS DONNELL JENKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PARIS DONNELL JENKINS

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1153 OAK ST
SAN FRANCISCO CA
94117
US

IV. Provider business mailing address

1746 15TH ST
SAN FRANCISCO CA
94103-3326
US

V. Phone/Fax

Practice location:
  • Phone: 415-431-9000
  • Fax:
Mailing address:
  • Phone: 415-216-6134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: