Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1356 | NM |
Y | 103T00000X | Psychologist | 1356 | NM |
NPI | 1013281534 |
---|---|
Provider Name | Dr. Seema Jacob |
First Address | Albuquerque, NM 87106-4374 |
Second Address | Albuquerque, NM 87107-1851 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2012 |
Last Update Date | 11/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013281534 | (05) | NM |