Provider Demographics
NPI:1376688549
Name:VAN VOERKENS, JACQUELINE MARIE
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MARIE
Last Name:VAN VOERKENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:MEURER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:764 SHELL AVE
Mailing Address - Street 2:APT . #3
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-3253
Mailing Address - Country:US
Mailing Address - Phone:925-370-2003
Mailing Address - Fax:
Practice Address - Street 1:2465 DOLAN WAY
Practice Address - Street 2:ROOM 29
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-1668
Practice Address - Country:US
Practice Address - Phone:510-741-2824
Practice Address - Fax:510-741-2903
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other