Healthcare Provider Details

I. General information

NPI: 1760627418
Provider Name (Legal Business Name): VALENTINE JAKOVLEVS JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 OLD YORK RD
ABINGTON PA
19001-3720
US

IV. Provider business mailing address

PO BOX 8500-5365
PHILADELPHIA PA
19178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 215-481-2000
  • Fax:
Mailing address:
  • Phone: 888-554-4121
  • Fax: 201-804-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN552918
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: