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General NPI Number Information
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NPI Number | 1104105071
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Entity Type | Organization
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Legal Business Name | JACOME MEDICAL GROUP
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Dates
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Enumeration Date | 08/10/2011
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Last Update Date | 08/10/2011
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Provider Practice Location Address
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Address Line | 72780 COUNTRY CLUB DR SUITE D403
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-4126
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Country | US
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Telephone | 760-773-2616
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Fax | 760-773-5797
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Provider Business Mailing Address
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Address Line | 72780 COUNTRY CLUB DR SUITE D403
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-4126
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Country | US
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Telephone | 760-773-2616
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Fax | 760-773-5797
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ENRIQUE G JACOME
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Credential | MD
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Telephone | 760-773-2616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A44682
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License Number State | CA
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