Healthcare Provider Details

I. General information

NPI: 1376563296
Provider Name (Legal Business Name): JACOB FLEISCHMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4841 HOLLYWOOD BLVD KAISER PERMANENTE
LOS ANGELES CA
90027-5301
US

IV. Provider business mailing address

131 N MARTEL AVE
LOS ANGELES CA
90074-0001
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-6454
  • Fax:
Mailing address:
  • Phone: 323-931-2555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberG40660
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberG40660
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: