Healthcare Provider Details

I. General information

NPI: 1902927148
Provider Name (Legal Business Name): JENNIFER A BARON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 09/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 DI SALVO AVE SUITE A
SAN JOSE CA
95128-1717
US

IV. Provider business mailing address

123 DI SALVO AVE SUITE A
SAN JOSE CA
95128-1717
US

V. Phone/Fax

Practice location:
  • Phone: 408-418-8780
  • Fax: 650-423-2976
Mailing address:
  • Phone: 408-418-8780
  • Fax: 650-423-2976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA92659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: