Individual
R MARVIN JABOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 524-1211
Mailing address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 524-1211
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
G60059
CA
2085R0202X
Diagnostic Radiology Physician
Primary
G60059
CA
2085R0204X
Vascular & Interventional Radiology Physician
G60059
CA
2085U0001X
Diagnostic Ultrasound Physician
G60059
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G600590
—
CA
Enumeration date
06/10/2006
Last updated
08/17/2010
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