MEDICARE: JENNIFER M EITEL MD

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	208000000X	Pediatrics Physician	N1711	TX
2	208000000X	Pediatrics Physician	A104530	CA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	LL1716	OTHER	NV	MEDICAL LICENSE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568588622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER M EITEL MD

Provider Business Mailing Address
First Line	:	6611 CEDARWOOD DR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-6659
Country	:	US
Telephone Number	:	714-308-6784
Fax Number	:

Provider Business Practice Location Address
First Line	:	6611 CEDARWOOD DR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-6659
Country	:	US
Telephone Number	:	714-308-6784
Fax Number	:

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	03/07/2023

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