Provider Demographics
NPI:1760796940
Name:BEN JACOB, ISALI (DOM)
Entity Type:Individual
Prefix:DR
First Name:ISALI
Middle Name:
Last Name:BEN JACOB
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 1:4505 W FLAGLER ST STE 202
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-1500
Mailing Address - Country:US
Mailing Address - Phone:786-220-0896
Mailing Address - Fax:
Practice Address - Street 1:4505 W FLAGLER ST STE 202
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1500
Practice Address - Country:US
Practice Address - Phone:786-220-0896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP847171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist