Healthcare Provider Details

I. General information

NPI: 1982846770
Provider Name (Legal Business Name): JODY MICHELLE JENSEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 CARMEN LN
SANTA MARIA CA
93458-7729
US

IV. Provider business mailing address

135 CARMEN LN
SANTA MARIA CA
93458-7729
US

V. Phone/Fax

Practice location:
  • Phone: 805-928-7361
  • Fax: 805-928-5742
Mailing address:
  • Phone: 805-928-7361
  • Fax: 805-928-5742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number19909
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: