Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | A60865 | CA |
NPI | 1164469201 |
---|---|
Provider Name | Dr. Jacob Nava Flores |
First Address | Oceanside, CA 92054-6229 |
Second Address | Oceanside, CA 92054-6229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 06/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A608650 | (05) | CA |
H28153 | (02) | CA |