Provider Demographics
NPI:1457682643
Name:KOMISAR, JACQUELINE SIMCHA
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SIMCHA
Last Name:KOMISAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 PATTERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4155
Mailing Address - Country:US
Mailing Address - Phone:925-938-8050
Mailing Address - Fax:925-938-8040
Practice Address - Street 1:550 PATTERSON BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4155
Practice Address - Country:US
Practice Address - Phone:925-938-8050
Practice Address - Fax:925-938-8040
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator