Provider Demographics
NPI:1801139175
Name:GABRIEL JACOB MD, A MEDICAL CORPORATION
Entity type:Organization
Organization Name:GABRIEL JACOB MD, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-423-2134
Mailing Address - Street 1:8120 TIMBERLAKE WAY
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-5412
Mailing Address - Country:US
Mailing Address - Phone:916-423-2134
Mailing Address - Fax:916-423-4477
Practice Address - Street 1:8120 TIMBERLAKE WAY
Practice Address - Street 2:SUITE 211
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5412
Practice Address - Country:US
Practice Address - Phone:916-423-2134
Practice Address - Fax:916-423-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty