Active NPI
Luis Alejandro Jacobo, MS, ATC
- Athletic Trainer
- Stockton, CA
National Provider Identifier
1003645920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2000053928
- Practice address
- 6385 Pacific Ave
Stockton, CA 95207-3713 - Phone
- (209) 477-9300
- NPI assigned
- Jul 30, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2000053928 | CA | Primary |
Addresses
Primary practice location
6385 Pacific Ave
Stockton, CA 95207-3713
Mailing address
3616 Jenny Lind Ave
North Highlands, CA 95660-5610
Phone (916) 208-4144
Other practice location 1
5648 N El Dorado St
Stockton, CA 95207-4459
Phone (209) 957-3340
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2000053928 | CA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1722297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722297600000",
"number": "1003645920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3616 JENNY LIND AVE",
"city": "NORTH HIGHLANDS",
"state": "CA",
"postal_code": "956605610",
"telephone_number": "916-208-4144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6385 PACIFIC AVE",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952073713",
"telephone_number": "209-477-9300"
}
],
"practiceLocations": [
{
"address_1": "5648 N El Dorado St",
"address_purpose": "LOCATION",
"city": "Stockton",
"state": "CA",
"postal_code": "952074459",
"country_code": "US",
"telephone_number": "209-957-3340",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JACOBO",
"first_name": "LUIS",
"middle_name": "ALEJANDRO",
"credential": "MS, ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-07-30",
"last_updated": "2024-07-30",
"certification_date": "2024-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "CA",
"license": "2000053928",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.