Provider Demographics
NPI:1073813341
Name:CALIFORNIA MARITIME ACADEMY
Entity Type:Organization
Organization Name:CALIFORNIA MARITIME ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVOST/VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKUBOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-654-1020
Mailing Address - Street 1:200 MARITIME ACADEMY DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-8181
Mailing Address - Country:US
Mailing Address - Phone:707-654-1170
Mailing Address - Fax:707-654-1171
Practice Address - Street 1:200 MARITIME ACADEMY DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-8181
Practice Address - Country:US
Practice Address - Phone:707-654-1170
Practice Address - Fax:707-654-1171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG057385261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health