Healthcare Provider Details

I. General information

NPI: 1740185024
Provider Name (Legal Business Name): KRISTEN M JACOBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3976 PO BOX 1679
SACRAMENTO CA
95812
US

IV. Provider business mailing address

3976 PO BOX 1679
SACRAMENTO CA
95812
US

V. Phone/Fax

Practice location:
  • Phone: 951-623-7286
  • Fax:
Mailing address:
  • Phone: 951-623-7286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number57762
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: