| David R Jensen Md A Professional Corporation | |
|
3011 Rancho Vista Blvd Suite B-c Palmdale CA 93551-4821 | |
| (661) 273-2556 | |
| (661) 267-4847 |
| Full Name | David R Jensen Md A Professional Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 3011 Rancho Vista Blvd, Palmdale, California |
| Authorized Official Name and Position | David Richard Jensen (OWNER) |
| Authorized Official Contact | 6612732556 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| David R Jensen Md A Professional Corporation 3011 Rancho Vista Blvd Suite B-c Palmdale CA 93551-4821 Ph: (661) 273-2556 | David R Jensen Md A Professional Corporation 3011 Rancho Vista Blvd Suite B-c Palmdale CA 93551-4821 Ph: (661) 273-2556 |
| NPI Number | 1518228980 |
|---|---|
| Provider Enumeration Date | 06/01/2012 |
| Last Update Date | 06/01/2012 |
| Medicare PECOS PAC ID | 4284904004 |
|---|---|
| Medicare Enrollment ID | O20170726002924 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518228980 | NPI | - | NPPES |
| G044704 | Medicaid | CA |
| Provider Name | David R Jensen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093731325 PECOS PAC ID: 3779749866 Enrollment ID: I20120717000584 |
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