Healthcare Provider Details

I. General information

NPI: 1962046243
Provider Name (Legal Business Name): JACOB ATKINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5266 HOLLISTER AVE STE 220
GOLETA CA
93111-3047
US

IV. Provider business mailing address

5266 HOLLISTER AVE STE 220
GOLETA CA
93111-3047
US

V. Phone/Fax

Practice location:
  • Phone: 805-403-7323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number10045
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number16215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: