Healthcare Provider Details

I. General information

NPI: 1760464945
Provider Name (Legal Business Name): JESSE P JOAD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

2516 STOCKTON BLVD DEPARTMENT OF PEDIATRICS
SACRAMENTO CA
95817-2208
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3189
  • Fax: 916-734-4757
Mailing address:
  • Phone: 916-734-3189
  • Fax: 916-734-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberC42593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: