Provider Demographics
NPI:1053377671
Name:MULLENAX, JEAN GAIL (MD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:GAIL
Last Name:MULLENAX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4305 UNIVERSITY AVE
Mailing Address - Street 2:STE 150
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1601
Mailing Address - Country:US
Mailing Address - Phone:619-563-0507
Mailing Address - Fax:619-563-0015
Practice Address - Street 1:4058 WILLOWS RD
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-1668
Practice Address - Country:US
Practice Address - Phone:619-445-1188
Practice Address - Fax:619-659-3140
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2012-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG66967208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics