Organization
DAVID R JENSEN MD A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID RICHARD JENSEN M.D. (OWNER)
(661) 273-2556
Entity
Organization
Contact information
Practice address
3011 RANCHO VISTA BLVD, SUITE B-C, PALMDALE, CA 93551-4821
(661) 273-2556
(661) 267-4847
Mailing address
3011 RANCHO VISTA BLVD, SUITE B-C, PALMDALE, CA 93551-4821
(661) 273-2556
(661) 267-4847
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
G044704
CA
291U00000X
Clinical Medical Laboratory
G044704
CA
302F00000X
Exclusive Provider Organization
G044704
CA
302R00000X
Health Maintenance Organization
G044704
CA
305R00000X
Preferred Provider Organization
G044704
CA
332BX2000X
Oxygen Equipment & Supplies (DME)
G044704
CA
3336M0002X
Mail Order Pharmacy
G044704
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G044704
—
CA
Enumeration date
06/01/2012
Last updated
06/01/2012
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