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1700638293
SHINY JACOB
REDLANDS, CA
NPI
1700638293
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: CA 95028911)
Enumeration Date
2024-04-05
Last Update Date
2024-04-05
Business Address
SHINY JACOB
1030 NEVADA ST
REDLANDS, CA 92374-2957
Phone number: 909-553-0055
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Mailing Address
SHINY JACOB
5360 CORISON WAY
FONTANA, CA 92336-5995
Phone number: 909-553-0055
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