Provider Demographics
NPI:1992298335
Name:NELDAM-VASQEUZ, JACOB
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:
Last Name:NELDAM-VASQEUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2068 WINDWARD PT
Mailing Address - Street 2:
Mailing Address - City:DISCOVERY BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94505-9513
Mailing Address - Country:US
Mailing Address - Phone:925-483-1752
Mailing Address - Fax:
Practice Address - Street 1:2068 WINDWARD PT
Practice Address - Street 2:
Practice Address - City:DISCOVERY BAY
Practice Address - State:CA
Practice Address - Zip Code:94505-9513
Practice Address - Country:US
Practice Address - Phone:925-483-1752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst