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General NPI Number Information
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NPI Number | 1477180172
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Entity Type | Individual
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Provider Name | JENNA EDIN CARLSON DO
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Gender | Female
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 01/28/2024
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Provider Practice Location Address
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Address Line | 4077 FIFTH AVE # MER35
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City | SAN DIEGO
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State | CA
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Zip | 92103-2105
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Country | US
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Telephone | 715-587-8171
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Fax |
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Provider Business Mailing Address
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Address Line | 435 H ST
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City | CHULA VISTA
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State | CA
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Zip | 91910-4307
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Country | US
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Telephone | 715-587-8171
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 20A20987
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License Number State | CA
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