Provider Demographics
NPI:1386273746
Name:DAZA, JENNIFER (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:DAZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1201 ALHAMBRA BLVD STE 340
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5242
Mailing Address - Country:US
Mailing Address - Phone:916-451-4400
Mailing Address - Fax:916-731-7955
Practice Address - Street 1:1201 ALHAMBRA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5241
Practice Address - Country:US
Practice Address - Phone:916-451-4400
Practice Address - Fax:916-731-7955
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA191246207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine