MEDICARE: DR. ENCHANTA L JENKINS 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	207V00000X	Obstetrics & Gynecology Physician	C143625	CA
2	208D00000X	General Practice Physician	200301268	NC
3	171000000X	Military Health Care Provider	200301268	NC
4	207V00000X	Obstetrics & Gynecology Physician	200301268	NC
5	207V00000X	Obstetrics & Gynecology Physician	01053687A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285604702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ENCHANTA L JENKINS M.D.

Provider Business Mailing Address
First Line	:	1374 S MISSION RD UNIT 429
Second Line	:
City	:	FALLBROOK
State	:	CA
Zip	:	92028-4006
Country	:	US
Telephone Number	:	760-909-9435
Fax Number	:	760-990-4523

Provider Business Practice Location Address
First Line	:	577 E ELDER ST STE F
Second Line	:
City	:	FALLBROOK
State	:	CA
Zip	:	92028-3079
Country	:	US
Telephone Number	:	760-645-3407
Fax Number	:	760-990-4523

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	09/17/2024

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Directions to “ DR. ENCHANTA L JENKINS M.D.” Practice Location

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