Jacob Alexander Virtusio

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

95296790 Issued in CA

Practice address

170 S Spruce Ave Ste 200
South San Francisco, CA 94080-4557

Phone

(650) 517-8220

NPI assigned

May 23, 2019

Last updated

Nov 14, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1558569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699920000000",
    "number": "1841857968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 S SPRUCE AVE STE 200",
            "city": "SOUTH SAN FRANCISCO",
            "state": "CA",
            "postal_code": "940804557",
            "telephone_number": "415-725-0755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 S SPRUCE AVE STE 200",
            "city": "SOUTH SAN FRANCISCO",
            "state": "CA",
            "postal_code": "940804557",
            "telephone_number": "650-517-8220"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2821 Crow Canyon Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "San Ramon",
            "state": "CA",
            "postal_code": "945831659",
            "country_code": "US",
            "telephone_number": "510-999-4410",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1801 Vicente St",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941162923",
            "country_code": "US",
            "telephone_number": "415-681-3211",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VIRTUSIO",
        "first_name": "JACOB",
        "middle_name": "ALEXANDER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-23",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95296790",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95296790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nurse Practitioner in South San Francisco, CA
• Providers in South San Francisco, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.