MEDICARE: JACOB MANJOORAN, MD, P.C.

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	2084P0800X	Psychiatry Physician	11276	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CC7754	OTHER		BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720346828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACOB MANJOORAN, MD, P.C.

Provider Business Mailing Address
First Line	:	2679 BOTHWELL PL
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89044-4400
Country	:	US
Telephone Number	:	702-480-7825
Fax Number	:

Provider Business Practice Location Address
First Line	:	3680 E SUNSET RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-7219
Country	:	US
Telephone Number	:	702-855-0748
Fax Number	:	702-486-4531

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JACOB MANJOORAN
Credential	:	MD
Telephone Number	:	702-480-7825

Provider Enumeration Date	:	04/25/2012
Last Update Date	:	06/03/2013

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