Individual
JAGAN MOHANRAO JAKKULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1809 W REDLANDS BLVD, REDLANDS, CA 92373-8054
(909) 335-3026
Mailing address
1809 W REDLANDS BLVD, REDLANDS, CA 92373-8054
(909) 335-3026
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
55923
MN
2084P0800X
Psychiatry Physician
Primary
C153085
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
390200000X
MARSHFIELD
WI
Enumeration date
07/10/2009
Last updated
11/23/2021
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