Organization
MEDICAL DIAGNOSTIC LABORATORIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID JENSEN MD (SOLE PROPRIETOR)
(209) 473-6555
Entity
Organization
Contact information
Practice address
3116 W MARCH LN STE 200, STOCKTON, CA 95219-2370
(209) 473-6555
(209) 473-6544
Mailing address
3116 W MARCH LN STE 200, STOCKTON, CA 95219-2370
(209) 473-6555
(209) 473-6544
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
G54073
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G540730
—
CA
01
—
G54073
CA LICENSE #
CA
Enumeration date
08/21/2006
Last updated
08/22/2020
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