Healthcare Provider Details

I. General information

NPI: 1477001485
Provider Name (Legal Business Name): JACOB FRANCISCO M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 CUMMINS DR
MODESTO CA
95358-6400
US

IV. Provider business mailing address

1620 CUMMINS DR
MODESTO CA
95358-6400
US

V. Phone/Fax

Practice location:
  • Phone: 209-622-1420
  • Fax: 209-491-0627
Mailing address:
  • Phone: 209-622-1420
  • Fax: 209-491-0627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: