Provider Demographics
NPI:1801246947
Name:JACOB, DAISEY THALIA-SANCHEZ (AUD)
Entity type:Individual
Prefix:
First Name:DAISEY
Middle Name:THALIA-SANCHEZ
Last Name:JACOB
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 UNIVERSITY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:EAST PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-2213
Mailing Address - Country:US
Mailing Address - Phone:650-462-3138
Mailing Address - Fax:
Practice Address - Street 1:1900 UNIVERSITY AVE STE 101
Practice Address - Street 2:
Practice Address - City:EAST PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-2213
Practice Address - Country:US
Practice Address - Phone:650-494-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3127231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist