Healthcare Provider Details

I. General information

NPI: 1235553173
Provider Name (Legal Business Name): JACQUELYN LOWMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELYN VELASQUEZ

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2514 BERRYESSA RD
SAN JOSE CA
95132-2947
US

IV. Provider business mailing address

250 BRANDON ST APT 124
SAN JOSE CA
95134-3441
US

V. Phone/Fax

Practice location:
  • Phone: 408-272-1431
  • Fax:
Mailing address:
  • Phone: 213-718-2269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95015293
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: