Healthcare Provider Details

I. General information

NPI: 1811221641
Provider Name (Legal Business Name): MILAGROS J. JACOBS-KLEISLI D.O., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2009
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E CHASE AVE SUITE 108
EL CAJON CA
92020-6305
US

IV. Provider business mailing address

3880 MURPHY CANYON RD. SUITE 200
SAN DIEGO CA
92123-4411
US

V. Phone/Fax

Practice location:
  • Phone: 619-442-2560
  • Fax: 619-442-7836
Mailing address:
  • Phone: 858-636-4300
  • Fax: 858-636-4319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A11985
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number005763
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: