Individual
JACOB MATTHEW PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LVN
Contact information
Practice address
718 WORKMAN STREET, BAKERSFIELD, CA 93307
(661) 859-5102
Mailing address
718 WORKMAN STREET, BAKERSFIELD, CA 93307
(661) 859-5102
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
739254
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1568219855
TELECARE CORPORATION
CA
Enumeration date
05/28/2024
Last updated
05/28/2024
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