Healthcare Provider Details

I. General information

NPI: 1285379750
Provider Name (Legal Business Name): JACOB GILBERTSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

1314 GARIBALDI CT
OCEANSIDE CA
92058-1006
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-2339
  • Fax:
Mailing address:
  • Phone: 509-475-2324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20A25163
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: