Provider Demographics
NPI:1316295942
Name:RICK JENKINS, M.D. INC
Entity type:Organization
Organization Name:RICK JENKINS, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-552-0146
Mailing Address - Street 1:1703 TERMINO AVE
Mailing Address - Street 2:STE.110
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2124
Mailing Address - Country:US
Mailing Address - Phone:310-552-0146
Mailing Address - Fax:310-552-0185
Practice Address - Street 1:1703 TERMINO AVE
Practice Address - Street 2:STE.110
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2124
Practice Address - Country:US
Practice Address - Phone:310-552-0146
Practice Address - Fax:310-552-0185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG697362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G697360Medicaid
WG69736CMedicare PIN