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General NPI Number Information
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NPI Number | 1790186708
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Entity Type | Individual
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Provider Name | CHARLES ANTHONY JENNINGS RN, NP
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Gender | Male
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Dates
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Enumeration Date | 09/09/2014
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Last Update Date | 09/10/2014
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Provider Practice Location Address
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Address Line | 1550 HOTEL CIR N SUITE 450
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City | SAN DIEGO
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State | CA
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Zip | 92108-2901
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Country | US
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Telephone | 619-692-1581
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Fax | 619-692-1588
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Provider Business Mailing Address
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Address Line | PO BOX 609001
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City | SAN DIEGO
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State | CA
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Zip | 92160-9001
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Country | US
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Telephone | 619-528-4600
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Fax | 619-528-4625
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95000764
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License Number State | CA
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