Healthcare Provider Details

I. General information

NPI: 1073470621
Provider Name (Legal Business Name): BRILYN JACOBSEN MEDICAL PRACTITIONER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 POLLASKY AVE BLDG 1/2
CLOVIS CA
93612-1840
US

IV. Provider business mailing address

724 POLLASKY AVE BLDG 1/2
CLOVIS CA
93612-1840
US

V. Phone/Fax

Practice location:
  • Phone: 559-207-3924
  • Fax:
Mailing address:
  • Phone: 559-207-3924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRILYN JACOBSEN
Title or Position: OWNER
Credential: NP
Phone: 747-214-4399