Individual
MARYLOU JACOBO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
10401 N CAVE CREEK RD LOT 306, PHOENIX, AZ 85020-1601
(623) 258-7712
Mailing address
10401 N CAVE CREEK RD LOT 306, PHOENIX, AZ 85020-1601
(623) 258-7712
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
1000026769
AZ
Other
Enumeration date
12/29/2020
Last updated
12/29/2020
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