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NPI Code Detail

MEDICARE: MR. JACOB OTIS

MEDICARE: MR. JACOB OTIS
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1245697952
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JACOB OTIS
Provider Business Mailing Address
First Line : 1765 PACIFIC AVE APT 5
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94109-2441
Country : US
Telephone Number : 714-418-8264
Fax Number :
Provider Business Practice Location Address
First Line : 1765 PACIFIC AVE APT 5
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94109-2441
Country : US
Telephone Number : 714-418-8264
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2016
Last Update Date : 01/26/2016

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Directions to “ MR. JACOB OTIS ” Practice Location

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