Provider Demographics
NPI:1659959492
Name:JACOBO OYOLA, CONCHITA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:CONCHITA
Middle Name:MARIA
Last Name:JACOBO OYOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. BUCARE
Mailing Address - Street 2:CALLE 13 ESMERALDA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-510-3388
Mailing Address - Fax:
Practice Address - Street 1:URB. BUCARE
Practice Address - Street 2:CALLE 13 ESMERALDA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-510-3388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJDCATEMP-037175208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice