Healthcare Provider Details

I. General information

NPI: 1669747127
Provider Name (Legal Business Name): JOSEPH JACOBS DPT, ASTRS, ACN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2012
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26895 ALISO CREEK RD STE B270
ALISO VIEJO CA
92656-5301
US

IV. Provider business mailing address

26895 ALISO CREEK RD STE B270
ALISO VIEJO CA
92656-5301
US

V. Phone/Fax

Practice location:
  • Phone: 888-210-2787
  • Fax: 949-236-6862
Mailing address:
  • Phone: 949-727-2192
  • Fax: 949-727-2193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number38861
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: