Provider Demographics
NPI:1306035696
Name:HOOVER, JESSE (DOM)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:
Last Name:HOOVER
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2241 CAMINO CARLOS REY
Mailing Address - Street 2:SUITE #20
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-5257
Mailing Address - Country:US
Mailing Address - Phone:505-471-3778
Mailing Address - Fax:
Practice Address - Street 1:2241 CAMINO CARLOS REY
Practice Address - Street 2:SUITE #20
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-5257
Practice Address - Country:US
Practice Address - Phone:505-471-3778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM936171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist