Provider Demographics
NPI:1073191102
Name:ARELLANO-ANDERSON, JACOB PAUL (MD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:PAUL
Last Name:ARELLANO-ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JACOB
Other - Middle Name:PAUL
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:995 POTRERO AVE BLDG 83
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2859
Mailing Address - Country:US
Mailing Address - Phone:628-206-5252
Mailing Address - Fax:
Practice Address - Street 1:1001 POTRERO AVE BLDG 80-83
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:628-206-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program