Most Relevant Information
Provider Data
| NPI Number: | 1003380288 |
| Provider Name: | JACOB T. DINES DO |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 01/22/2019 |
| Last Updated: | 07/21/2021 |
Provider Practice Location
1 ADMINISTRATION CIR # MS 1015
RIDGECREST
CA
935556104
Practice Location Phone/Fax
| Phone: | 7609398063 |
| Fax: |
Provider Mailing Location
1 ADMINISTRATION CIR # MS 1015
RIDGECREST
CA
935556104
Provider Mailing Phone/Fax
| Phone: | 7609398063 |
| Fax: |