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General NPI Number Information
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NPI Number | 1508124074
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Entity Type | Organization
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Legal Business Name | PABLO JACOBO DDS, INC
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Dates
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Enumeration Date | 05/02/2012
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Last Update Date | 09/20/2016
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Provider Practice Location Address
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Address Line | 1035 W ROBINHOOD DR SUITE 200
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City | STOCKTON
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State | CA
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Zip | 95207-5621
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Country | US
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Telephone | 209-952-3687
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Fax | 209-952-6267
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Provider Business Mailing Address
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Address Line | 1035 W ROBINHOOD DR SUITE 200
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City | STOCKTON
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State | CA
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Zip | 95207-5621
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Country | US
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Telephone | 209-952-3687
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Fax | 209-952-6267
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Authorized Official
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Title or Position | MANAGER
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Name | MR. CARLOS JACOBO
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Credential |
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Telephone | 209-952-3687
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 60929
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 61240
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 100679
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 38433
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License Number State | CA
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