JACOB BLOTTER (NPI# 1588282396) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588282396 |
| Entity Type | Individual |
| Full Name | JACOB BLOTTER |
| Credential | MD |
| Practice Address |
101 Bodin Cir Fairfield CA 94535-1809 |
| Practice Telephone | 7074233000 |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2020-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | Behavioral Health & Social Service Providers |
| Street Address |
101 BODIN CIR |
| City | FAIRFIELD |
| State | CA |
| Zip Code | 94535-1809 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912504093 | Dallas Mcwilliams | Military Health Care Provider | 101 Bodin Cir, Fairfield, CA 94535-1809 | 2020-10-02 |
| 1669082897 | Sahra K. Pak | Dietitian, Registered | 101 Bodin Cir, Fairfield, CA 94535-1809 | 2020-08-03 |
| 1164031407 | Abigail Greenwell | Student in an Organized Health Care Education/Training Program | 101 Bodin Cir, Fairfield, CA 94535-1809 | 2020-07-22 |
| 1851919468 | Derek P Brady | Military Health Care Provider | 101 Bodin Cir, Fairfield, CA 94535-1809 | 2020-07-09 |
| 1154947679 | Daniel Warren Cline | Student in an Organized Health Care Education/Training Program | 101 Bodin Cir, Fairfield, CA 94535-1809 | 2020-06-20 |
| 1477174654 | Robert Dillon Hill | Student in an Organized Health Care Education/Training Program | 101 Bodin Cir, Fairfield, CA 94535-1809 | 2020-04-29 |
| 1124653878 | Hana L Ha | Pharmacist | 101 Bodin Cir, Fairfield, CA 94535-1809 | 2020-03-03 |
| 1972137644 | Audrey Nicole Imperial | Student in an Organized Health Care Education/Training Program | 101 Bodin Cir, Fairfield, CA 94535-1809 | 2020-03-02 |
| 1366074163 | Christian Heinrich Kniep | Student in an Organized Health Care Education/Training Program | 101 Bodin Cir, Fairfield, CA 94535-1809 | 2020-02-10 |
| 1457983751 | Jeffery Michael Lerma | Student in an Organized Health Care Education/Training Program | 101 Bodin Cir, Fairfield, CA 94535-1809 | 2020-02-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508487711 | Sheila C Flood | Student in an Organized Health Care Education/Training Program | 101 Biden Circle, Fairfield, CA 94535 | 2020-04-28 |
| 1568081255 | Miguel Julian Moreno | Student in an Organized Health Care Education/Training Program | 690 Airmen Drive, Travis Afb, CA 94535 | 2020-04-13 |
| 1174096101 | Zlatoslava Karga | Nurse Practitioner | 60mdg / Sgow, 101 Bodin Circle, Travis Afb, CA 94535 | 2019-01-02 |
| 1437648292 | Luke C Vera | Dentist | David Grant Medical Center 101 Bodin Circle, Travis Air Force Base, CA 94535 | 2018-05-08 |
| 1588163430 | Sanaz Ziad | Pharmacist | 60mdg/mdts, 101 Bodin Circle, Travis Afb, CA 94535 | 2018-02-06 |
| 1194265686 | Geoffrey Johnston | Dentist | 60 Mdg/sgdd, 101 Bodin Circle, Travis Afb, CA 94535 | 2017-03-02 |
| 1336693407 | Hannah Isla Nordwall | Social Worker | 60 Mdg/mdos 101 Bodin Cir, Travis Afb, CA 94535 | 2016-08-06 |
| 1184177149 | Taylor Murrie-robinson | Social Worker | 60mdg / Sgow Mental Health Clinic, 101 Bodin Circle, Travis Afb, CA 94535 | 2016-07-26 |
| 1952759607 | Eric Kincaid-sharp | General Practice | 60 Mdg/amds, 101 Bodin Cir, Travis Afb, CA 94535 | 2016-06-02 |
| 1023472040 | Genieve Marie Martinez-hernandez | Internal Medicine | 60 Mdg/sgomi, 101 Bodin Circle, Fairfield, CA 94535 | 2016-04-06 |
| Find all providers in zip 94535 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629675624 | Natasha A Ridosh | Counselor | 2750 N Texas St Unit 7206, Fairfield, CA 94533-1176 | 2020-10-03 |
| 1003424219 | Amanda Kate Tubb | Counselor | 1601 Union Ave Apt 2, Fairfield, CA 94533-3731 | 2020-07-14 |
| 1447877964 | Victoria Larrieu Sebourne | Counselor | 35 Montauk St, Fairfield, CT 06825-1606 | 2020-06-30 |
| 1851913305 | Christian Vazquez | Counselor | 5114 Bickford Cir, Fairfield, CA 94533-6574 | 2020-05-07 |
| 1952923492 | Lionesha Nashell Lewis | Counselor | 701 E Travis Blvd Apt 13, Fairfield, CA 94533-8754 | 2020-05-07 |
| 1922629971 | Juan Carlos Cardenas | Counselor | 877 Sunset Ct, Fairfield, CA 94533-4145 | 2020-04-30 |
| 1518587013 | Jaime Quesada | Counselor | 1357 Astoria Dr, Fairfield, CA 94534-4325 | 2020-04-24 |
| 1871113316 | Scott D Wagner I | Counselor | 319 E Tabor Ave Apt 15319, Fairfield, CA 94533-3955 | 2020-04-24 |
| 1871113597 | Krystal Hill | Counselor | 2999 N Texas St Apt 23, Fairfield, CA 94533-1283 | 2020-04-22 |
| 1922561232 | Johnece M Smith | Counselor | 5010 Gary Ave, Fairfield, AL 35064-1349 | 2019-04-12 |
| Find all providers in FAIRFIELD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.