Healthcare Provider Details

I. General information

NPI: 1215864293
Provider Name (Legal Business Name): ADAM JACOBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23504 LYONS AVE STE 402
NEWHALL CA
91321-5777
US

IV. Provider business mailing address

23504 LYONS AVE STE 402
NEWHALL CA
91321-5777
US

V. Phone/Fax

Practice location:
  • Phone: 661-977-4747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: