Provider Demographics
NPI:1366869471
Name:SISCO, JENNIFER LOEB (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LOEB
Last Name:SISCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:MICHELLE
Other - Last Name:LOEB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2020 ZONAL AVE # IRD723
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-0121
Mailing Address - Country:US
Mailing Address - Phone:323-409-7184
Mailing Address - Fax:
Practice Address - Street 1:ST. JOHN'S REGIONAL MEDICAL CENTER -1600 N ROSE AVENUE
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:805-485-3025
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA148364207RC0200X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease