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NPI Code Detail

MEDICARE: JACOB PRATT

MEDICARE: JACOB PRATT
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
1103T00000XPsychologist

General Provider Information

NPI Number : 1265275143
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB PRATT
Provider Business Mailing Address
First Line : PO BOX 53
Second Line :
City : PORT COSTA
State : CA
Zip : 94569-0053
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1470 MARIA LN STE 240
Second Line :
City : WALNUT CREEK
State : CA
Zip : 94596-5399
Country : US
Telephone Number : 510-214-3434
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2024
Last Update Date : 06/17/2024

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Directions to “ JACOB PRATT ” Practice Location

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