JAKE DANIEL VAN WEEZEP

FAIRFIELD, CA
NPI1720669393
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207Q00000X Family Medicine
(Licence: IN  02006978A)
Additional Taxonomies208D00000X General Practice
(Licence: IN  02006978A)
Enumeration Date2021-04-15
Last Update Date2024-07-15
Business Address
JAKE DANIEL VAN WEEZEP
101 BODIN CIR
FAIRFIELD, CA 94535-1809
Phone number: 707-423-7961
Mailing Address
JAKE DANIEL VAN WEEZEP
101 BODIN CIR
FAIRFIELD, CA 94535-1809
Phone number: 707-423-3057