Organization
CANDICE JENSEN MD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CANDICE MICHELLE JENSEN MD (SOLE MEMBER)
(928) 344-3250
Entity
Organization
Contact information
Practice address
2503 S AVE A, SUITE 3, YUMA, AZ 85364-7173
(928) 344-3250
(928) 344-3253
Mailing address
2503 S AVE A, SUITE 3, YUMA, AZ 85364-7173
(928) 344-3250
(928) 344-3253
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
38206
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Z148161
MEDICARE PTAN
AZ
Enumeration date
08/05/2008
Last updated
02/21/2012
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