Provider Demographics
NPI:1427120658
Name:JENNINGS, MARY C (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:C
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4501 MISSION BAY DR
Mailing Address - Street 2:#1E
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109
Mailing Address - Country:US
Mailing Address - Phone:858-270-9611
Mailing Address - Fax:858-270-1725
Practice Address - Street 1:4501 MISSION BAY DR
Practice Address - Street 2:#1E
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109
Practice Address - Country:US
Practice Address - Phone:858-270-9611
Practice Address - Fax:858-270-1725
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2011-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG55908207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE60886Medicaid
CA00G559081Medicaid
CA00G559081Medicaid
CAG555908Medicare ID - Type Unspecified
CAE60886Medicaid