Provider Demographics
NPI:1811174576
Name:AKINDELE, JACOB TAIWO (ARDCS)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:TAIWO
Last Name:AKINDELE
Suffix:
Gender:M
Credentials:ARDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 RUSSETT WAY
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-2112
Mailing Address - Country:US
Mailing Address - Phone:775-443-8282
Mailing Address - Fax:
Practice Address - Street 1:2535 JENSEN AVE
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-2288
Practice Address - Country:US
Practice Address - Phone:559-876-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103502246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography