Healthcare Provider Details

I. General information

NPI: 1730281411
Provider Name (Legal Business Name): MARGARITA WAJA TZOKA-JACOBS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 MARTIN LUTHER KING JR WAY
OAKLAND CA
94612-1318
US

IV. Provider business mailing address

130 GILL WAY
BENICIA CA
94510-1612
US

V. Phone/Fax

Practice location:
  • Phone: 510-267-7909
  • Fax:
Mailing address:
  • Phone: 707-745-4327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6358
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: