Provider Demographics
NPI:1194254995
Name:NGAKAM, JAQUES (PA)
Entity type:Individual
Prefix:
First Name:JAQUES
Middle Name:
Last Name:NGAKAM
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19790 OAK FLAT RD APT D
Mailing Address - Street 2:
Mailing Address - City:HIDDEN VALLEY LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95467-8588
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 11TH ST
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-8107
Practice Address - Country:US
Practice Address - Phone:707-263-3746
Practice Address - Fax:707-263-3749
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA54323363A00000X
MAPA6144363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant