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NPI Code Detail

MEDICARE: JACOB ONEILL

MEDICARE: JACOB ONEILL
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCA

General Provider Information

NPI Number : 1790633709
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB ONEILL
Provider Business Mailing Address
First Line : 1680 N FAIR OAKS AVE
Second Line :
City : PASADENA
State : CA
Zip : 91103-1642
Country : US
Telephone Number : 626-798-0884
Fax Number :
Provider Business Practice Location Address
First Line : 1680 N FAIR OAKS AVE
Second Line :
City : PASADENA
State : CA
Zip : 91103-1642
Country : US
Telephone Number : 626-798-0884
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2026
Last Update Date : 03/17/2026

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Directions to “ JACOB ONEILL ” Practice Location

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