Healthcare Provider Details

I. General information

NPI: 1235984592
Provider Name (Legal Business Name): ISAIAH MANUEL JACQUES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2024
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 BROADWAY ST
REDWOOD CITY CA
94063-3132
US

IV. Provider business mailing address

430 BROADWAY ST
REDWOOD CITY CA
94063-3132
US

V. Phone/Fax

Practice location:
  • Phone: 650-723-5643
  • Fax:
Mailing address:
  • Phone: 650-721-7669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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: