Healthcare Provider Details

I. General information

NPI: 1518965771
Provider Name (Legal Business Name): JENNIFER L BETTS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 STONY POINT RD
SANTA ROSA CA
95401-4122
US

IV. Provider business mailing address

144 STONY POINT RD
SANTA ROSA CA
95401-4122
US

V. Phone/Fax

Practice location:
  • Phone: 707-521-4541
  • Fax: 707-544-4626
Mailing address:
  • Phone: 707-521-4541
  • Fax: 707-544-4626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA72470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: