Provider Demographics
NPI:1285604702
Name:JENKINS, ENCHANTA L (MD)
Entity type:Individual
Prefix:DR
First Name:ENCHANTA
Middle Name:L
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1374 S MISSION RD UNIT 429
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-4006
Mailing Address - Country:US
Mailing Address - Phone:760-909-9435
Mailing Address - Fax:760-990-4523
Practice Address - Street 1:577 E ELDER ST STE F
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-3079
Practice Address - Country:US
Practice Address - Phone:760-645-3407
Practice Address - Fax:760-990-4523
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC143625207V00000X
NC200301268208D00000X, 171000000X, 207V00000X
IN01053687A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100000668Medicaid