Provider Demographics
NPI:1285258236
Name:JACOBA, CRIS MARTIN PACIS (MD)
Entity type:Individual
Prefix:DR
First Name:CRIS MARTIN
Middle Name:PACIS
Last Name:JACOBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8495 ARIES RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-1811
Mailing Address - Country:US
Mailing Address - Phone:858-322-7073
Mailing Address - Fax:
Practice Address - Street 1:180 DAGGETT DR
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4667
Practice Address - Country:US
Practice Address - Phone:413-452-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2023-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1014967207W00000X
MAETLL-1196207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty