Healthcare Provider Details

I. General information

NPI: 1821509480
Provider Name (Legal Business Name): JACOB PLAFKER CCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2017
Last Update Date: 10/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 4TH ST
SAN FRANCISCO CA
94143-2351
US

IV. Provider business mailing address

1469 BELLEVUE AVE
BURLINGAME CA
94010-3987
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-0567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: