MEDICARE: JACLYN HASTINGS M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	69973	WI

General Provider Information

NPI Number	:	1821523994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN HASTINGS M.D.

Provider Business Mailing Address
First Line	:	1 EMBARCADERO CTR STE 1900
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94111-3723
Country	:	US
Telephone Number	:	415-658-6791
Fax Number	:	415-252-7176

Provider Business Practice Location Address
First Line	:	26 THOMSON PL
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02210-1212
Country	:	US
Telephone Number	:	888-663-6331
Fax Number	:	415-252-7176

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

Provider Enumeration Date	:	04/26/2017
Last Update Date	:	04/18/2025

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