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General NPI Number Information
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NPI Number | 1922232404
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Entity Type | Individual
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Provider Name | JENNIFER M VAN WARMERDAM M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/12/2009
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Last Update Date | 09/08/2023
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Provider Practice Location Address
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Address Line | 1 SHRADER ST SUITE 650
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City | SAN FRANCISCO
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State | CA
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Zip | 94117-1016
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Country | US
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Telephone | 415-221-0665
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Fax | 415-221-0687
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Provider Business Mailing Address
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Address Line | 3400 DATA DR ATTN CREDENTIALING/PAYER ENROLLMENT
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670-7956
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A96120
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License Number State | CA
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