Provider Demographics
NPI:1487269072
Name:JESSICA MARIE ADKINS MD PC
Entity type:Organization
Organization Name:JESSICA MARIE ADKINS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-908-8100
Mailing Address - Street 1:415 ROLLING OAKS DRIVE SUITE 260
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1033
Mailing Address - Country:US
Mailing Address - Phone:805-908-8100
Mailing Address - Fax:
Practice Address - Street 1:415 ROLLING OAKS DRIVE
Practice Address - Street 2:SUITE 260
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1033
Practice Address - Country:US
Practice Address - Phone:805-908-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty