Healthcare Provider Details

I. General information

NPI: 1770656407
Provider Name (Legal Business Name): TROY ANTHONY JACOBS MD, MPH, FAAP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W 17TH ST RM. 115M
SANTA ANA CA
92706-2316
US

IV. Provider business mailing address

250 W OCEAN BLVD UNIT 1603
LONG BEACH CA
90802-7939
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-8411
  • Fax: 714-834-8051
Mailing address:
  • Phone: 562-495-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA85595
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number37035
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: