Provider Demographics
NPI:1093163032
Name:PRICE, JENNIFER (PA-C, MMS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PRICE
Suffix:
Gender:
Credentials:PA-C, MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 REGENTS PARK ROW STE 345
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-9102
Mailing Address - Country:US
Mailing Address - Phone:858-926-7010
Mailing Address - Fax:858-926-7011
Practice Address - Street 1:4150 REGENTS PARK ROW STE 345
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-9102
Practice Address - Country:US
Practice Address - Phone:858-926-7010
Practice Address - Fax:858-926-7011
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA53435363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical