Jacqueline Grey Etemad, M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

A21746 Issued in CA

Practice address

15 Venado Dr
Tiburon, CA 94920-1634

Phone

(415) 435-2776

Fax

(415) 435-9415

NPI assigned

Jun 29, 2011

Last updated

Jun 29, 2011By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1309305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309305600000",
    "number": "1396032363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 VENADO DR",
            "city": "TIBURON",
            "state": "CA",
            "postal_code": "949201634",
            "telephone_number": "415-435-2776",
            "fax_number": "415-435-9415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 VENADO DR",
            "city": "TIBURON",
            "state": "CA",
            "postal_code": "949201634",
            "telephone_number": "415-435-2776",
            "fax_number": "415-435-9415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETEMAD",
        "first_name": "JACQUELINE",
        "middle_name": "GREY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-29",
        "last_updated": "2011-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "CA",
            "license": "A21746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Child & Adolescent Psychiatry Physician in Tiburon, CA
• Providers in Tiburon, CA by specialty
• Child & Adolescent Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.