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General NPI Number Information
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NPI Number | 1245617497
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Entity Type | Individual
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Provider Name | LAURA JACOBSON
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Gender | Female
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Dates
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Enumeration Date | 04/27/2015
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Last Update Date | 11/03/2021
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Provider Practice Location Address
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Address Line | LOMA LINDA UNIVERSITY # GENERAL 11234 ANDERSON STREET
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City | LOMA LINDA
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State | CA
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Zip | 92354-2741
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Country | US
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Telephone | 909-558-4174
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Fax |
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Provider Business Mailing Address
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Address Line | 11234 ANDERSON ST GME OFFICE WESTERLY SUITE 'C'
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City | LOMA LINDA
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State | CA
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Zip | 92350-1716
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Country | US
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Telephone |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A144951
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License Number State | CA
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