Individual
JESSIE K JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2421 PARK BLVD STE B202, PALO ALTO, CA 94306-1956
(650) 617-8655
Mailing address
2421 PARK BLVD STE B202, PALO ALTO, CA 94306-1956
(650) 617-8655
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
242480
NY
2085R0202X
Diagnostic Radiology Physician
Primary
A107083
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A107083
MEDICAL LICENSE
CA
Enumeration date
07/04/2006
Last updated
12/30/2020
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