JEFFENSEN JAY TIMACDOG (NPI# 1083103956) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083103956 |
| Entity Type | Individual |
| Full Name | JEFFENSEN JAY TIMACDOG |
| Practice Address |
2175 Park Pl El Segundo CA 90245-4705 |
| Mailing Address |
7047 Camino Revueltos Unit 324 San Diego CA 92111-7698 |
| Practice Telephone | 8183378701 |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2019-02-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
NP95008823 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
2175 PARK PL |
| City | EL SEGUNDO |
| State | CA |
| Zip Code | 90245-4705 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285884098 | Anish Thomas Peter | Internal Medicine | 2175 Park Pl, El Segundo, CA 90245-4705 | 2008-09-29 |
| 1306344122 | Stephanie Lynn Fanous | Nurse Practitioner | 2175 Park Pl, El Segundo, CA 90245-4705 | 2018-01-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366058976 | Britt'nee Cornelius | Massage Therapist | 222 North PCh, Suite 2000, El Segundo, CA 90245 | 2020-09-18 |
| 1750913778 | Laurie Ann Scoppetto | Dietitian, Registered | 482 N Aviation Blvd, El Segundo, CA 90245 | 2020-02-07 |
| 1972135283 | A Dabrowska Dds, Inc | Dentist | 390 N. Pacific Coast Hwy #1050, El Segundo, CA 90245 | 2020-02-05 |
| 1578023057 | Miles Bertumen | Pharmacist | 283 N Aviation Blvd, Building 210, El Segundo, CA 90245 | 2019-03-21 |
| 1831673201 | Kriss L. Killam | Marriage & Family Therapist | 302 W. Grand Ave., Suite 9, El Segundo, CA 90245 | 2018-09-20 |
| 1811487911 | Bright Light Recovery | Substance Abuse Rehabilitation Facility | 218 Concord St, Suite C, El Segundo, CA 90245 | 2018-05-14 |
| 1265950448 | Sarah Yuriko Mizuki | Physician Assistant | 390 N PCh, Suite 1000, El Segundo, CA 90245 | 2017-09-07 |
| 1326586462 | Jlp Interpreting Services | Interpreter | 963 Virginia St #5, El Segundo, CA 90245 | 2017-02-09 |
| 1619351707 | El Segundo Dermatology, Inc. | Specialist | 713 N Douglas St., El Segundo, CA 90245 | 2015-07-17 |
| 1083956635 | 24hr Homecare, LLC | Home Health | 200 N. Pacific Coast Highway, Suite 300, El Segundo, CA 90245 | 2013-03-21 |
| Find all providers in zip 90245 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679122592 | Yuan Zhao | Nurse Practitioner | 2101 Rosecrans Ave # 3230, El Segundo, CA 90245-4749 | 2019-09-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235738782 | Peninsula Healthcare Center | Nurse Practitioner | 22330 Hawthorne Blvd Ste 208, Torrance, CA 90505-2536 | 2020-10-25 |
| 1710584008 | Venessa Beck | Nurse Practitioner | 903 Cardiff St, San Diego, CA 92114-5019 | 2020-10-08 |
| 1053918094 | Janel Nicole Sanglerat | Nurse Practitioner | 416 Aviation Blvd, Santa Rosa, CA 95403-1032 | 2020-10-02 |
| 1790382760 | Christopher Tran | Nurse Practitioner | 11441 Heacock St Ste F, Moreno Valley, CA 92557-7907 | 2020-10-02 |
| 1487266292 | Mollie Shira Hudson | Nurse Practitioner | 14 Whitmore Pl Apt 15, Oakland, CA 94611-4635 | 2020-08-21 |
| 1962014381 | Mario Javier Herrera | Nurse Practitioner | 2130 High Pointe Dr, Apt 108, Corona, CA 92879 | 2020-08-18 |
| 1952912131 | Norman Ivan Kier | Nurse Practitioner | 3834 Edison Ave, Sacramento, CA 95821-2728 | 2020-08-12 |
| 1942811377 | Thanhan Mathews | Nurse Practitioner | 114 W Cameron St Apt B, Hanford, CA 93230-2965 | 2020-08-10 |
| 1972113355 | Marine Mary Kademyan | Nurse Practitioner | 6528 Babcock Ave, North Hollywood, CA 91606 | 2020-07-31 |
| 1245849645 | Shannon Pereira | Nurse Practitioner | 2368 Honeysuckle Way, Hemet, CA 92545-4796 | 2020-07-31 |
| Find all providers with the same taxonomy | ||||
| City | EL SEGUNDO |
| Zip Code | 90245 |
Please comment or provide details below to improve the information on JEFFENSEN JAY TIMACDOG.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.