Green-Jacob, Johanna

Green-Jacob, Johanna is an individual health care provider with primary practice located at 823 Gateway Center Way , San Diego CA 92102-4541. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Green-Jacob, Johanna can be contacted via phone (619) 515-2300.

Contact Information

Primary practice address
823 Gateway Center Way San Diego CA 92102-4541
Phone: (619) 515-2300
Fax: (619) 906-4564
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 13014 California

Profile Details

NPI number 1609863968
LBN Legal business name Green-Jacob, Johanna
Credentials NURSE PRACTITIONER
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 3rd, 2005
Last updated Feb 25th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609863968 NPPES
California Other PTAN WNP13014A

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