Individual
BREANNE M JAQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1501 N GILBERT RD, GILBERT, AZ 85234-2390
(480) 728-4100
Mailing address
1501 N GILBERT RD FL 1, GILBERT, AZ 85234-2390
(480) 728-4100
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
008620
AZ
207P00000X
Emergency Medicine Physician
34.013802
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/03/2017
Last updated
02/10/2022
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