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General NPI Number Information
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NPI Number | 1093010480
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Entity Type | Organization
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Legal Business Name | JACOB RISPLER MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/17/2011
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Last Update Date | 01/17/2011
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Provider Practice Location Address
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Address Line | 246 W COLLEGE ST 3RD FLOOR
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City | COVINA
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State | CA
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Zip | 91723-1910
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Country | US
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Telephone | 626-915-1911
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Fax | 626-915-2668
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Provider Business Mailing Address
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Address Line | 246 W COLLEGE ST 3RD FLOOR
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City | COVINA
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State | CA
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Zip | 91723-1910
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Country | US
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Telephone | 626-915-1911
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Fax | 626-915-2668
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACOB RISPLER
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Credential | M.D.
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Telephone | 626-915-1911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | G33285
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License Number State | CA
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