MEDICARE: JACOB ELI REF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1295538676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB ELI REF

Provider Business Mailing Address
First Line	:	12180 E COLUMBINE DR
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85259-2814
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 THE CITY DR S
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-3204
Country	:	US
Telephone Number	:	714-456-7890
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2025
Last Update Date	:	03/31/2025

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Directions to “ JACOB ELI REF ” Practice Location

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