Healthcare Provider Details

I. General information

NPI: 1780950857
Provider Name (Legal Business Name): BRENDA P. JACOBS, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 LINDEN AVE #1
LONG BEACH CA
90807-4577
US

IV. Provider business mailing address

3550 LINDEN AVE #1
LONG BEACH CA
90807-4577
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-7889
  • Fax: 562-595-1335
Mailing address:
  • Phone: 562-595-7889
  • Fax: 562-595-1335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberG45847
License Number StateCA

VIII. Authorized Official

Name: DR. BRENDA PENNY JACOBS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: M.D.
Phone: 562-595-7889