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Jake Daniel Van Weezep
General Practice Physician in Fairfield, California
NPI 1720669393

Jake Daniel Van Weezep is a General Practice Physician based in Fairfield, CA. Jake Daniel Van Weezep practices in Fairfield, CA. The NPI Number for Jake Daniel Van Weezep is 1720669393 and holds a License No. (California).

The current practice location address for Jake Daniel Van Weezep is 101 Bodin Cir, Fairfield, CA and can be reached out via phone at 707-423-3048.

Location: 101 Bodin Cir, Fairfield, CA, 94535-1809
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1720669393
Provider Name
Jake Daniel Van Weezep
Credential
Provider Entity Type
Individual
Gender
Male
Address
101 Bodin Cir, Fairfield, CA, 94535-1809
Phone Number
707-423-3048
Fax Number
Provider Enumeration Date
04/15/2021
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
101 Bodin Cir
City
Fairfield
State
California
Zip
94535-1809
Phone Number
707-423-3048
Fax Number
person
Provider Business Mailing Address Details
Address
101 Bodin Cir
City
Fairfield
State
California
Zip
94535-1809
Phone Number
707-423-3048
Fax Number
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
General Practice
Speciality
-
Taxonomy
208D00000X
License No.
02006978A (Indiana)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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