MEDICARE: JANNA LYN DOHERTY 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	A64380	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

General Provider Information

NPI Number	:	1790898823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANNA LYN DOHERTY M.D.

Provider Business Mailing Address
First Line	:	1779 DOMINICAN WAY
Second Line	:	SUITE B
City	:	SANTA CRUZ
State	:	CA
Zip	:	95065-1526
Country	:	US
Telephone Number	:	831-479-4966
Fax Number	:	831-479-4967

Provider Business Practice Location Address
First Line	:	1779 DOMINICAN WAY
Second Line	:	SUITE B
City	:	SANTA CRUZ
State	:	CA
Zip	:	95065-1526
Country	:	US
Telephone Number	:	831-479-4966
Fax Number	:	831-479-4967

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	12/13/2021

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