Healthcare Provider Details

I. General information

NPI: 1174441778
Provider Name (Legal Business Name): JACOB MICHAEL ADAMOVIC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3759 GONDAR AVE
LONG BEACH CA
90808-2130
US

IV. Provider business mailing address

601 BROCTON CT UNIT 103
LONG BEACH CA
90803-6338
US

V. Phone/Fax

Practice location:
  • Phone: 562-481-4849
  • Fax:
Mailing address:
  • Phone: 562-481-4849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: