Healthcare Provider Details

I. General information

NPI: 1063124105
Provider Name (Legal Business Name): HILDA BERENICE JACOBO FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8727 VAN NUYS BLVD
PANORAMA CITY CA
91402-2451
US

IV. Provider business mailing address

922 S BARRINGTON AVE APT 102
LOS ANGELES CA
90049-5537
US

V. Phone/Fax

Practice location:
  • Phone: 818-899-5555
  • Fax:
Mailing address:
  • Phone: 407-965-7846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95022808
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: