Individual
TIMOTHY MICHAEL JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1801 VICENTE ST, SAN FRANCISCO, CA 94116-2923
(415) 681-3211
Mailing address
3204 SHATTUCK AVE, BERKELEY, CA 94705-1825
(415) 913-0303
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
36563
CA
Other
Enumeration date
05/28/2013
Last updated
05/28/2013
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