Provider Demographics
NPI:1386896264
Name:KNOX BARLEBEN, JENNIFER LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:KNOX BARLEBEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:KNOX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:JENNIFER LYNN KNOX
Mailing Address - Street 1:PO BOX 3579
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-8579
Mailing Address - Country:US
Mailing Address - Phone:657-241-3600
Mailing Address - Fax:657-241-7708
Practice Address - Street 1:361 HOSPITAL RD STE 322
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3524
Practice Address - Country:US
Practice Address - Phone:949-574-0777
Practice Address - Fax:949-650-3505
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98912207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB259427Medicare PIN
CABH154ZMedicare PIN
CABG773ZMedicare PIN