Provider Demographics
NPI:1699496927
Name:CIARAN JACKA DPM INC
Entity type:Organization
Organization Name:CIARAN JACKA DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CIARAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:510-374-8213
Mailing Address - Street 1:3031 DOHR ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-2713
Mailing Address - Country:US
Mailing Address - Phone:510-374-8213
Mailing Address - Fax:
Practice Address - Street 1:2089 VALE RD STE 12
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3848
Practice Address - Country:US
Practice Address - Phone:510-232-0892
Practice Address - Fax:510-234-5951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric