Healthcare Provider Details

I. General information

NPI: 1548957350
Provider Name (Legal Business Name): MARIANNA JOLLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 N MILL ST
TEHACHAPI CA
93561-1384
US

IV. Provider business mailing address

99 BEAUVOIR AVE
SUMMIT NJ
07901-3533
US

V. Phone/Fax

Practice location:
  • Phone: 866-707-6664
  • Fax:
Mailing address:
  • Phone: 908-522-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA206668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: