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Individual
JEANINE M ELLINWOOD
Active
Individual
JEANINE M ELLINWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G80715
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110131834
RAILROAD MEDICARE
CA
01
—
C006
TRICARE
CA
Enumeration date
07/01/2005
Last updated
11/23/2011
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