Provider Demographics
NPI:1063495182
Name:JACINTO, JOLLY R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOLLY
Middle Name:R
Last Name:JACINTO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 768
Mailing Address - Street 2:380 N RESERVATION RD
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93258-0768
Mailing Address - Country:US
Mailing Address - Phone:559-784-2136
Mailing Address - Fax:559-781-6514
Practice Address - Street 1:380 N RESERVATION RD
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-9673
Practice Address - Country:US
Practice Address - Phone:559-784-2136
Practice Address - Fax:559-781-6514
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA36113207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine