Individual
IMMANUEL JACQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1959 NE PACIFIC ST BOX 356410, SEATTLE, WA 98195-6140
(559) 901-1335
Mailing address
1130 W MICHIGAN ST # FH204, INDIANAPOLIS, IN 46202-5209
(559) 901-1335
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A184944
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/11/2016
Last updated
07/03/2023
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