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General NPI Number Information
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NPI Number | 1801039615
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Entity Type | Individual
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Provider Name | JENNIFER AVISE MD
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Gender | Female
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Dates
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Enumeration Date | 04/08/2009
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Last Update Date | 11/12/2024
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Provider Practice Location Address
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Address Line | 5924 STONERIDGE DR STE 108
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City | PLEASANTON
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State | CA
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Zip | 94588-5400
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Country | US
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Telephone | 925-892-4290
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Fax |
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Provider Business Mailing Address
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Address Line | 5924 STONERIDGE DR STE 108
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City | PLEASANTON
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State | CA
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Zip | 94588-5400
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Country | US
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Telephone |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A137711
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | A137711
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License Number State | CA
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