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NPI Code Detail

MEDICARE: PENELOPE JACOBS

MEDICARE: PENELOPE JACOBS
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1336907674
Entity Type Code : Individual
Provider Name (Legal Business Name) : PENELOPE JACOBS
Provider Business Mailing Address
First Line : 16255 VENTURA BLVD STE 830
Second Line :
City : ENCINO
State : CA
Zip : 91436-2317
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2376 RED CLIFFS DR
Second Line :
City : SAINT GEORGE
State : UT
Zip : 84790-8367
Country : US
Telephone Number : 801-935-4171
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2024
Last Update Date : 03/11/2024

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Directions to “ PENELOPE JACOBS ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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