MEDICARE: MARITZA YESCAS JACOBO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1700357837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARITZA YESCAS JACOBO

Provider Business Mailing Address
First Line	:	279 BALSAM AVE
Second Line	:
City	:	BRIGHTON
State	:	CO
Zip	:	80601-2909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11860 PECOS ST
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80234-2740
Country	:	US
Telephone Number	:	720-523-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2018
Last Update Date	:	12/16/2018

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Directions to “ MARITZA YESCAS JACOBO ” Practice Location

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