Healthcare Provider Details

I. General information

NPI: 1184717894
Provider Name (Legal Business Name): ILYANA MARGARITA JACOBSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W SANTA ANA BLVD STE 600
SANTA ANA CA
92701-4552
US

IV. Provider business mailing address

600 W SANTA ANA BLVD STE 600
SANTA ANA CA
92701-4552
US

V. Phone/Fax

Practice location:
  • Phone: 714-953-4455
  • Fax: 915-772-5133
Mailing address:
  • Phone: 714-953-4455
  • Fax: 714-542-2793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number24487
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: