Individual
JACOB LEVI NICOLAS VERDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AAS
Contact information
Practice address
9825 GARDEN GROVE BLVD, GARDEN GROVE, CA 92844-1616
(714) 766-5244
Mailing address
11490 LA VERNE DR, RIVERSIDE, CA 92505-2560
(951) 818-6786
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary
UNLICENCED
CA
Other
Enumeration date
02/20/2026
Last updated
02/20/2026
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