Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | G15026 | CA |
NPI | 1023192101 |
---|---|
Provider Name | Lester B. Jacobson |
First Address | San Francisco, CA 94115-2382 |
Second Address | San Francisco, CA 94115-2382 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 23/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0714817 | (05) | CA |
A39411 | (02) |