Provider Demographics
NPI:1700280518
Name:DOWLING, JACOB (RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:DOWLING
Suffix:
Gender:M
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:JACOB
Other - Middle Name:K
Other - Last Name:DOWLING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, LD, CDE
Mailing Address - Street 1:1850 SPRING RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-6100
Mailing Address - Country:US
Mailing Address - Phone:530-251-1420
Mailing Address - Fax:
Practice Address - Street 1:2211 LOMAS BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2719
Practice Address - Country:US
Practice Address - Phone:505-272-6632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86031343133V00000X
NMLD-1258133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered