1740031434 NPI number — JULIE FISHER JACOBY MA, PPS

Table of content: JULIE FISHER JACOBY MA, PPS (NPI 1740031434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740031434 NPI number — JULIE FISHER JACOBY MA, PPS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACOBY
Provider First Name:
JULIE
Provider Middle Name:
FISHER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, PPS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FISHER
Provider Other First Name:
JULIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, PPS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740031434
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17520 REDWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASTRO VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94546-1434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-736-3198
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17520 REDWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASTRO VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94546-1434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-537-0630
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YS0200X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)