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General NPI Number Information
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NPI Number | 1467306134
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Entity Type | Individual
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Provider Name | JACOB LEVI NICOLAS VERDE AAS
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Gender | Male
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Dates
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Enumeration Date | 02/20/2026
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Last Update Date | 02/20/2026
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Provider Practice Location Address
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Address Line | 9825 GARDEN GROVE BLVD
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City | GARDEN GROVE
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State | CA
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Zip | 92844-1616
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Country | US
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Telephone | 714-766-5244
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Fax |
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Provider Business Mailing Address
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Address Line | 11490 LA VERNE DR
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City | RIVERSIDE
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State | CA
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Zip | 92505-2560
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Country | US
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Telephone | 951-818-6786
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number | UNLICENCED
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License Number State | CA
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