Black, Jennifer Michelle

Black, Jennifer Michelle is an individual health care provider with primary practice located at 1000 Vale Terrace Dr , Vista CA 92084-5218. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Hospitalist. Allopathic & Osteopathic Physicians / Internal Medicine is her primary health care specialty. Black, Jennifer Michelle can be contacted via phone (760) 631-5000.

Contact Information

Primary practice address
1000 Vale Terrace Dr Vista CA 92084-5218
Phone: (760) 631-5000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 43773-020 Wisconsin
Allopathic & Osteopathic Physicians / Hospitalist 208M00000X 43773-020 Wisconsin
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X A84075 California

Profile Details

NPI number 1194763326
LBN Legal business name Black, Jennifer Michelle
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 2nd, 2006
Last updated Sep 28th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194763326 NPPES
Wisconsin MEDICAID 34469600

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