Provider Demographics
NPI:1265401988
Name:JENSEN, JACLYN ALANE (DO)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:ALANE
Last Name:JENSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12710 CARMEL COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2153
Mailing Address - Country:US
Mailing Address - Phone:858-794-3815
Mailing Address - Fax:
Practice Address - Street 1:12710 CARMEL COUNTRY RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2153
Practice Address - Country:US
Practice Address - Phone:858-794-3815
Practice Address - Fax:858-481-9755
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A 9415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine