Provider Demographics
NPI:1093343220
Name:STRAUS, JACOB
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:STRAUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4503 TERRACE HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-1555
Mailing Address - Country:US
Mailing Address - Phone:206-276-6328
Mailing Address - Fax:
Practice Address - Street 1:4205 WHEATON WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3665
Practice Address - Country:US
Practice Address - Phone:360-782-6392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program