Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | G76901 | CA |
NPI | 1215920673 |
---|---|
Provider Name | Dr. Joshua Samuel Jacobs |
First Address | Walnut Creek, CA 94598-3045 |
Second Address | Walnut Creek, CA 94598-3045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2005 |
Last Update Date | 22/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H09495 | (02) | CA |