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General NPI Number Information
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NPI Number | 1447508023
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Entity Type | Individual
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Provider Name | JENNIFER JANE JALLO PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 2910 N 3RD AVE # 330
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City | PHOENIX
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State | AZ
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Zip | 85013-4434
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Country | US
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Telephone | 602-406-8811
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Fax |
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Provider Business Mailing Address
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Address Line | 240 W THOMAS RD #301
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City | PHOENIX
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State | AZ
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Zip | 85013
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Country | US
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Telephone | 602-406-7765
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5158
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License Number State | AZ
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