Provider Demographics
NPI:1942300942
Name:JACOME, ENRIQUE G (MD)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:G
Last Name:JACOME
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ENRIQUE
Other - Middle Name:G
Other - Last Name:JACOME
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD INC
Mailing Address - Street 1:72780 COUNTRY CLUB DR
Mailing Address - Street 2:SUITE A103
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4126
Mailing Address - Country:US
Mailing Address - Phone:760-779-5511
Mailing Address - Fax:760-773-3320
Practice Address - Street 1:72780 COUNTRY CLUB DR
Practice Address - Street 2:SUITE A103
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4126
Practice Address - Country:US
Practice Address - Phone:760-779-5511
Practice Address - Fax:760-773-3320
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44682207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology