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MR. LAWRENCE JASON JACOBS SFIDC
Independent Duty Corpsman >> Military Health Care Provider >> Other Service ProvidersRegistrant NPI Number: 1003243338
Individual Registrant:MR. LAWRENCE JASON JACOBS SFIDC
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
34949 VISCARIA CT WINCHESTER, CA 92596-8968 US
Tel: 260-740-6714 Fax: --
Tel: 260-740-6714 Fax: --
Contact information for business:
34949 VISCARIA CT WINCHESTER, CA 92596-8968 US
Tel: 260-740-6714 Fax: --
Tel: 260-740-6714 Fax: --
Registration Information:
NPI: 1003243338
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 1710I1002X | Other Service Providers Military Health Care Provider Independent Duty Corpsman |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
