Most Relevant Information
Provider Data
| NPI Number: | 1003243338 |
| Provider Name: | LAWRENCE JASON JACOBS SFIDC |
| Entity Type: | Individual |
| Taxonomy Code: | 1710I1002X |
| Specialty: | Military Health Care Provider |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/01/2013 |
| Last Updated: | 10/01/2013 |
Provider Practice Location
34949 VISCARIA CT
WINCHESTER
CA
925968968
Practice Location Phone/Fax
| Phone: | 2607406714 |
| Fax: |
Provider Mailing Location
34949 VISCARIA CT
WINCHESTER
CA
925968968
Provider Mailing Phone/Fax
| Phone: | 2607406714 |
| Fax: |