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Individual

MR. JACOB T. DINES

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
1 ADMINISTRATION CIR # MS 1015, RIDGECREST, CA 93555-6104
(760) 939-8063
Mailing address
1 ADMINISTRATION CIR # MS 1015, RIDGECREST, CA 93555-6104
(760) 939-8063

Taxonomy

Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
OS17059
FL
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
01/22/2019
Last updated
07/21/2021
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