Individual ProviderLinidia J Willies-JacoboPediatricsAllopathic & Osteopathic PhysiciansPractice Address7910 Frost St., Suite 350, San Diego, CA 92123-2753(858) 496-4800(858) 502-1135PECOS EnrollmentBased on the most recent information from CMS, provider Linidia J Willies-Jacobo does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 2:29 PM.Profile DetailsProvider ID1174556179Provider TypeIndividualFull NameWillies-Jacobo, Linidia JTitleDr.CredentialM.D.GenderFemaleSole ProprietorNoEnumeration Date7/10/2006Last Updated3/27/2015Contact InformationPractice LocationPractice Address7910 Frost St., Suite 350, San Diego, CA 92123-2753Phone(858) 496-4800Fax(858) 496-4850Mailing LocationMailing Address3860 Calle Fortunada, Suite 200, San Diego, CA 92123-4802Phone(858) 502-1135Fax(858) 636-4319Provider TaxonomiesCodeDescriptionLicenseCode208000000XPrimaryDescriptionPediatricsAllopathic & Osteopathic PhysiciansLicenseG78269CaliforniaProvider IdentifiersIDDescriptionIssuerID00G782690DescriptionMedicaidIssuerUnlistedCalifornia