Healthcare Provider Details

I. General information

NPI: 1982544821
Provider Name (Legal Business Name): JADE EMMANNY BATUNGBACAL MARCOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ALHAMBRA AVE
MARTINEZ CA
94553-3156
US

IV. Provider business mailing address

138 FIG TREE LN APT 11C
MARTINEZ CA
94553-6516
US

V. Phone/Fax

Practice location:
  • Phone: 925-370-5117
  • Fax: 925-370-5052
Mailing address:
  • Phone: 650-642-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number1982544821
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: