| Organization Name: | JACOBS MEDICAL SUPPLY,LLC |
| NPI Number: | 1124386495 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JERRY VALERA NERIA (PRESIDENT) |
| Mailing Address: | 8213 Crichton Way Elk Grove |
| State: | CA US |
| Postal Code: | 957588028 |
| Phone Number: | 9166474193 |
| Fax Number: | 9168965115 |
| NPI Enumeration Date: | 04/24/2012 |
| NPI Last Update Date: | 04/24/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 201013710108 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |