Healthcare Provider Details

I. General information

NPI: 1801693783
Provider Name (Legal Business Name): JACOB MICHAEL SHERFIELD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 MITCHELL BLVD SUITE 104
SAN RAFAEL CA
94903
US

IV. Provider business mailing address

65 MITCHELL BLVD SUITE 104
SAN RAFAEL CA
94903
US

V. Phone/Fax

Practice location:
  • Phone: 415-455-8481
  • Fax:
Mailing address:
  • Phone: 415-455-8481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: