# JOHN J. JOLLEY, M.D. A PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053607903
- **Authorized official:** DR. JOHN J. JOLLEY M.D. (PRESIDENT)
- **Authorized official phone:** (415) 888-2755

## Contact information

- **Practice address:** 750 LAS GALLINAS AVE STE 106, SAN RAFAEL, CA 94903-3408
- **Practice address phone:** (415) 888-2755
- **Practice address fax:** (415) 888-2754
- **Mailing address:** 750 LAS GALLINAS AVE STE 106, SAN RAFAEL, CA 94903-3408
- **Mailing address phone:** (415) 888-2755
- **Mailing address fax:** (415) 888-2754

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | G021951 | CA | Yes |

## Other

- **Enumeration date:** 06/20/2011
- **Last updated:** 04/16/2020