Provider Demographics
NPI:1376709444
Name:TRESKOVICH, JACOB ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:ANTHONY
Last Name:TRESKOVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:455 HICKEY BLVD
Mailing Address - Street 2:SUITE 414
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2629
Mailing Address - Country:US
Mailing Address - Phone:650-301-4960
Mailing Address - Fax:650-301-4961
Practice Address - Street 1:455 HICKEY BLVD
Practice Address - Street 2:SUITE 414
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2629
Practice Address - Country:US
Practice Address - Phone:650-301-4960
Practice Address - Fax:650-301-4961
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1274902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry