Provider Demographics
NPI:1831797059
Name:JACOBO, GUADALUPE (CAREGIVER)
Entity type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:
Last Name:JACOBO
Suffix:
Gender:F
Credentials:CAREGIVER
Other - Prefix:
Other - First Name:GUADALUPE
Other - Middle Name:
Other - Last Name:JACOBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:GUADALUPE JACOBO
Mailing Address - Street 1:8114 GLENSCOTT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77061-2408
Mailing Address - Country:US
Mailing Address - Phone:832-815-9729
Mailing Address - Fax:
Practice Address - Street 1:5627 LAUREL CREEK WAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-6838
Practice Address - Country:US
Practice Address - Phone:832-374-9146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26135295374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty