Healthcare Provider Details

I. General information

NPI: 1184556375
Provider Name (Legal Business Name): JACOB GRABB PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

12460 OSPREY LN APT 3
LOS ANGELES CA
90094-3244
US

IV. Provider business mailing address

12460 OSPREY LN APT 3
LOS ANGELES CA
90094-3244
US

V. Phone/Fax

Practice location:
  • Phone: 310-200-0899
  • Fax:
Mailing address:
  • Phone: 310-200-0899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95039812
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: