Individual
DR. CANDICE MICHELLE JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D., PLLC
Contact information
Practice address
2503 S AVE A, STE 3, YUMA, AZ 85364-7173
(928) 344-3250
(928) 344-3253
Mailing address
2503 S AVE A, STE 3, YUMA, AZ 85364-7173
(928) 344-3250
(928) 344-3253
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
38206
AZ
208600000X
Surgery Physician
A100498
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0A1004980
—
CA
05
—
340763
—
AZ
01
—
Z148161
MEDICARE PTAN
AZ
Enumeration date
05/08/2007
Last updated
02/20/2012
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