Healthcare Provider Details

I. General information

NPI: 1376284703
Provider Name (Legal Business Name): ELIAS INGA JACO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MOUNT VERNON AVE
BAKERSFIELD CA
93306-4018
US

IV. Provider business mailing address

1700 MOUNT VERNON AVE
BAKERSFIELD CA
93306-4018
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-2200
  • Fax: 661-326-2950
Mailing address:
  • Phone: 661-326-2200
  • Fax: 661-326-2950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA201552
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA201552
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: