Provider Demographics
NPI:1699780049
Name:DOLBY, JENNIFER (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:DOLBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11216 CAMINITO INOCENTA
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-6106
Mailing Address - Country:US
Mailing Address - Phone:858-547-0555
Mailing Address - Fax:
Practice Address - Street 1:2210 MESA DR
Practice Address - Street 2:SUITE 12
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-3756
Practice Address - Country:US
Practice Address - Phone:760-966-3306
Practice Address - Fax:760-966-3310
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71269208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF77310Medicare UPIN