Healthcare Provider Details

I. General information

NPI: 1922645829
Provider Name (Legal Business Name): JENSEN PHILIP ARDMS, RVT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 AIRPORT BLVD
SOUTH SAN FRANCISCO CA
94080-6530
US

IV. Provider business mailing address

808 WINDBLOWN LN
REDWOOD CITY CA
94065-8424
US

V. Phone/Fax

Practice location:
  • Phone: 650-995-2444
  • Fax:
Mailing address:
  • Phone: 650-995-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: