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NPI Code Detail

MEDICARE: JACOB SUR

MEDICARE: JACOB SUR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianCA

General Provider Information

NPI Number : 1013834274
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB SUR
Provider Business Mailing Address
First Line : 10707 HEATHER RIDGE DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92130-6940
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3878 RUFFIN RD STE B
Second Line :
City : SAN DIEGO
State : CA
Zip : 92123-1842
Country : US
Telephone Number : 619-795-9925
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2026
Last Update Date : 06/30/2026

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Directions to “ JACOB SUR ” Practice Location

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