MEDICARE: MS. DENISE JACOBS RN

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	163W00000X	Registered Nurse	493772	CA

General Provider Information

NPI Number	:	1336395409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENISE JACOBS RN

Provider Business Mailing Address
First Line	:	1134 E 1ST ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-5618
Country	:	US
Telephone Number	:	562-606-7557
Fax Number	:

Provider Business Practice Location Address
First Line	:	1134 E 1ST ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90802-5618
Country	:	US
Telephone Number	:	562-606-7557
Fax Number	:

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

Provider Enumeration Date	:	08/08/2008
Last Update Date	:	08/08/2008

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