Healthcare Provider Details

I. General information

NPI: 1598686362
Provider Name (Legal Business Name): JACOB EDWARD SCHOLL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9921 CARMEL MOUNTAIN RD # 2317
SAN DIEGO CA
92129-2813
US

IV. Provider business mailing address

9921 CARMEL MOUNTAIN RD # 2317
SAN DIEGO CA
92129-2813
US

V. Phone/Fax

Practice location:
  • Phone: 858-216-5513
  • Fax:
Mailing address:
  • Phone: 858-216-5513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number36754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: