Provider Demographics
NPI:1396958047
Name:HAIAVY, JACOB (MD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:
Last Name:HAIAVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8680 MONROE CT.
Mailing Address - Street 2:#200
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730
Mailing Address - Country:US
Mailing Address - Phone:909-987-0899
Mailing Address - Fax:909-987-9399
Practice Address - Street 1:8680 MONROE CT
Practice Address - Street 2:#200
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4880
Practice Address - Country:US
Practice Address - Phone:909-987-0899
Practice Address - Fax:909-987-9399
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA69766208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery