Individual
JACOB DYLAN LUKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
935B SPRING ST, PLACERVILLE, CA 95667-4523
(530) 621-6213
Mailing address
1891 CEDAR OAK RD, PLACERVILLE, CA 95667-7883
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
95345401
CA
Other
Enumeration date
02/05/2024
Last updated
02/05/2024
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