Individual
DR. JENNIFER LYNN BAYNOSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1707 W CHARLESTON BLVD, #160, LAS VEGAS, NV 89102-2351
(702) 671-5150
(702) 384-6493
Mailing address
PO BOX 516558, LOS ANGELES, CA 90051-0596
(702) 671-2391
(702) 895-4014
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
12653
NV
2086X0206X
Surgical Oncology Physician
Primary
12653
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184748212
—
NV
01
—
V51698
PTAN
NV
Enumeration date
03/16/2007
Last updated
02/27/2018
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