Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | A100287 | CA |
N | 207N00000X | Dermatologist | ME89945 | FL |
NPI | 1053349688 |
---|---|
Provider Name | Sharon Jacob-Soo |
First Address | San Diego, CA 92123-4802 |
Second Address | San Diego, CA 92123-4802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 25/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2704986-00 | (05) | FL |
I16287 | (02) | FL |