MEDICARE: DR. JENNIFER BENNITT DECONDE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A108554	CA

General Provider Information

NPI Number	:	1205064326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER BENNITT DECONDE M.D.

Provider Business Mailing Address
First Line	:	4910 DIRECTORS PL
Second Line	:	SUITE 250
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3811
Country	:	US
Telephone Number	:	858-249-5400
Fax Number	:

Provider Business Practice Location Address
First Line	:	4910 DIRECTORS PL
Second Line	:	SUITE 250
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3811
Country	:	US
Telephone Number	:	858-249-5400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2009
Last Update Date	:	03/26/2014

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