Organization
JESSIE JACOB MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE K JACOB MD (PRESIDENT)
(914) 282-6171
Entity
Organization
Contact information
Practice address
900 WELCH RD, SUITE 101, PALO ALTO, CA 94304-1805
(650) 617-8655
Mailing address
900 WELCH RD, SUITE 101, PALO ALTO, CA 94304-1805
(650) 617-8655
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A107083
CALIFORNIA LICENCE
CA
Enumeration date
12/06/2012
Last updated
12/06/2012
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