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General NPI Number Information
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NPI Number | 1174634356
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Entity Type | Individual
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Provider Name | JENNIFER SOLOMON MATTOX NP
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 97 SAN MARIN DR
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City | NOVATO
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State | CA
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Zip | 94945-1100
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Country | US
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Telephone | 415-899-7525
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Fax | 415-899-7623
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Provider Business Mailing Address
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Address Line | KAISER PERMANENTE NOVATO MEDICAL OFFICES 97 SAN MARIN DR.
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City | NOVATO
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State | CA
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Zip | 94945
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Country | US
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Telephone | 415-899-7525
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Fax | 415-899-7623
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | RN- 514466, NP- 9992
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License Number State | CA
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