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General NPI Number Information
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NPI Number | 1124299532
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Entity Type | Individual
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Provider Name | MIRIAM JOY JACOBS J.D., PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 03/13/2008
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Provider Practice Location Address
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Address Line | 8950 VILLA LA JOLLA DR C-207
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City | LA JOLLA
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State | CA
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Zip | 92037-1714
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Country | US
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Telephone | 858-534-8067
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Fax |
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Provider Business Mailing Address
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Address Line | 8950 VILLA LA JOLLA DR C-207
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City | LA JOLLA
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State | CA
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Zip | 92037-1714
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Country | US
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Telephone | 858-534-8067
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 21885
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License Number State | CA
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