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General NPI Number Information
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NPI Number | 1649659772
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Entity Type | Individual
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Provider Name | JACOB MARQUETTE DO
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Gender | Male
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Dates
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Enumeration Date | 05/21/2015
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 2170 SOUTH AVE
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-7026
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Country | US
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Telephone | 530-541-3420
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Fax |
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Provider Business Mailing Address
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Address Line | 3291 LOMA VISTA RD
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City | VENTURA
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State | CA
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Zip | 93003-3099
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Country | US
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Telephone | 805-652-6100
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Fax | 805-652-3252
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.0060772
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number | 15073
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 15073
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License Number State | CA
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