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General NPI Number Information
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NPI Number | 1104950807
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Entity Type | Individual
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Provider Name | JAKUB JUROS MD
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Gender | Male
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 03/28/2013
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Provider Practice Location Address
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Address Line | 11080 W OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90064-1937
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Country | US
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Telephone | 310-966-6500
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Fax | 310-473-0831
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Provider Business Mailing Address
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Address Line | 11080 W OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90064-1937
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Country | US
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Telephone | 310-966-6500
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Fax | 310-473-0831
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A100526
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036114133
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License Number State | IL
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