Individual
DR. JACK OSCAR PIASECKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
17400 IRVINE BLVD, SUITE L, TUSTIN, CA 92780-3030
(714) 508-1112
(714) 508-3653
Mailing address
17400 IRVINE BLVD, SUITE L, TUSTIN, CA 92780-3030
(714) 508-1112
(714) 508-3653
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
G53516
CA
Other
Enumeration date
02/20/2007
Last updated
07/08/2007
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