Provider Demographics
NPI:1578607198
Name:KROCK, JACQUELINE DESITTER (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:DESITTER
Last Name:KROCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3324 STATE ST STE I
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-2672
Mailing Address - Country:US
Mailing Address - Phone:805-563-0933
Mailing Address - Fax:805-845-0606
Practice Address - Street 1:3324 STATE ST STE I
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-2672
Practice Address - Country:US
Practice Address - Phone:805-563-0933
Practice Address - Fax:805-845-0606
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66938207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine