MEDICARE: JESSICA TOVAR

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
1	174400000X	Specialist

General Provider Information

NPI Number	:	1356122261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA TOVAR

Provider Business Mailing Address
First Line	:	222 MILBRAE LN APT 17
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95032-7388
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1275 LINCOLN AVE STE 14B
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125-3049
Country	:	US
Telephone Number	:	408-893-6450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2023
Last Update Date	:	10/09/2023

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