Healthcare Provider Details

I. General information

NPI: 1619553542
Provider Name (Legal Business Name): JESSENIA ALICIA ELSA KNOWLES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N MAIN ST
SANTA ANA CA
92701-3576
US

IV. Provider business mailing address

800 N MAIN ST
SANTA ANA CA
92701-3576
US

V. Phone/Fax

Practice location:
  • Phone: 657-282-6355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-24553-0
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: