JENNIFER G. SHAW, MD, A PROFESSIONAL CORPORATION (NPI# 1912298704) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912298704 |
| Entity Type | Organization |
| Organization Name | JENNIFER G. SHAW, MD, A PROFESSIONAL CORPORATION |
| Practice Address |
4077 Fifth Ave San Diego CA 92103 |
| Mailing Address |
17101 Saint Andrews Dr Poway CA 92064-1226 |
| Practice Telephone | 6192607231 |
| Practice Fax Number | 6192607165 |
| Mailing Telephone | 6192607231 |
| Mailing Fax Number | 8583128040 |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2016-05-30 |
| Authorized Official Name | DR. JENNIFER G SHAW (PRESIDENT) |
| Authorized Official Telephone | 6192607231 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | A88810 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
4077 FIFTH AVE |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306808464 | Eric Dahms | Internal Medicine | 4077 Fifth Ave, San Diego, CA 92103-2105 | 2006-04-04 |
| 1528672532 | Orlando Manzano | Nurse Practitioner | 4077 Fifth Ave, San Diego, CA 92103-2105 | 2020-09-07 |
| 1518570167 | Lindsay Gumm | Social Worker | 4077 Fifth Ave, San Diego, CA 92103-2105 | 2020-08-24 |
| 1821608811 | Tammy V Pham, M.d., Apc | Obstetrics & Gynecology | 4077 Fifth Ave, San Diego, CA 92103-2105 | 2020-08-04 |
| 1891310538 | Jordan Ray Noble | Nurse Practitioner | 4077 Fifth Ave, San Diego, CA 92103-2105 | 2020-06-09 |
| 1861014714 | Merril Lindner | Dietetic Technician, Registered | 4077 Fifth Ave, San Diego, CA 92103-2105 | 2020-05-14 |
| 1215559042 | Kevin Kavanagh | Pharmacist | 4077 Fifth Ave, San Diego, CA 92103-2105 | 2020-05-14 |
| 1942821525 | Page Staley Hope Moore | Occupational Therapist | 4077 Fifth Ave, San Diego, CA 92103-2105 | 2020-05-05 |
| 1316568033 | Brent Conrad Beckner | Pharmacist | 4077 Fifth Ave, San Diego, CA 92103-2105 | 2020-05-04 |
| 1306474101 | Kate Hebert Pool | Student in an Organized Health Care Education/Training Program | 4077 Fifth Ave, San Diego, CA 92103-2105 | 2020-03-29 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174140057 | Carmel Agdeppa | Acupuncturist | Chiropractique, 813 West Washington St., San Diego, CA 92103 | 2020-06-26 |
| 1568082717 | Salina Ann Bambic | Social Worker | 302 Washington Street Suite 420, San Diego, CA 92103 | 2020-04-17 |
| 1467099432 | Lina Hong | Behavior Technician | 3731 6th Ave. Suite 100, San Diego, Ca 92103, San Diego, CA 92103 | 2019-12-09 |
| 1154964567 | Rodger Stacy Questin, Psychologist P.C. | Psychologist | 440 Upas St Apt 402, San Diego, CA 92103 | 2019-10-18 |
| 1932740388 | Grace Tong-ventura | Pharmacist | 200 W. Arbor Drive, #8765, Suite 1-317, San Diego, CA 92103 | 2019-10-07 |
| 1306490453 | Genevieve Cheung | Pharmacist | 200 W Arbor Dr #8765, Department of Pharmacy, San Diego, CA 92103 | 2019-07-26 |
| 1801356837 | Marika Doviak | Acupuncturist | 2370 Hickory St, San Diego, CA 92103 | 2019-03-25 |
| 1982185070 | Tyler Lewis Roberts | Counselor | 4303 3rd Ave, San Diego, CA 92103 | 2018-08-27 |
| 1689151284 | Tori Breanne Blackwell | Occupational Therapist | 3731-a 6th Avenue, San Diego, CA 92103 | 2018-07-26 |
| 1952892614 | Pacific Bay Recovery Inc | Substance Abuse Rehabilitation Facility | 4095 Jackdaw St, San Diego, CA 92103 | 2018-05-29 |
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| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316494768 | Samantha Berg | Obstetrics & Gynecology | 9339 Genesee Ave Ste 220, San Diego, CA 92121-2121 | 2016-09-01 |
| 1326495276 | Elizabeth Anne Coulter | Obstetrics & Gynecology | 200 West Arbor Drive, Mc8433, Ucsd Residency Office, San Diego, CA 92103 | 2016-05-20 |
| 1962889121 | Reproductive Sciences Medical Center | Obstetrics & Gynecology | 3661 Valley Centre Dr, Suite 100, San Diego, CA 92130-3321 | 2015-04-27 |
| 1134515695 | Tiffani Phan | Obstetrics & Gynecology | 550 Washington St Ste 331, San Diego, CA 92103-2227 | 2015-04-11 |
| 1437544251 | Lindsey Ann Burnett | Obstetrics & Gynecology | 200 West Arbor Drive, Mailcode 8433, University of California San Diego, San Diego, CA 92103 | 2015-03-30 |
| 1811240906 | Charles Hamrang | Obstetrics & Gynecology | 3250 Bunker Hill, San Diego, CA 92117 | 2012-10-26 |
| 1780955328 | Gerald M Spector | Obstetrics & Gynecology | 4045 Couts St, San Diego, CA 92103-1501 | 2012-01-12 |
| 1841578572 | L Dale Lapp M D Inc | Obstetrics & Gynecology | 4060 4th Ave Ste 640, San Diego, CA 92103-2118 | 2011-07-29 |
| 1114221603 | Leroy Albert Miller | Obstetrics & Gynecology | 2359 Juan Street, San Diego, CA 92103 | 2010-12-27 |
| 1154635415 | Robert J Santella, Md. Inc. | Obstetrics & Gynecology | 4531 College Ave, San Diego, CA 92115-4010 | 2010-07-28 |
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| 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.