Jensen, Gary L

Jensen, Gary L is an individual health care provider with primary practice located at 255 E Bonita Ave , Pomona CA 91767-1923. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Jensen, Gary L can be contacted via phone (909) 450-0393.

Contact Information

Primary practice address
255 E Bonita Ave Pomona CA 91767-1923
Phone: (909) 450-0393
Fax: (909) 450-0394
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X A43613 California

Profile Details

NPI number 1558304139
LBN Legal business name Jensen, Gary L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 13th, 2006
Last updated Jul 8th, 2007 - about 17 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 1558304139 NPPES
California MEDICAID 00A436130
California Other 00A436130

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