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General NPI Number Information
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NPI Number | 1265483226
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Entity Type | Individual
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Provider Name | SCOTT BENTLEY JACOBS M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 11301 WILSHIRE BLVD BUILDING 500, RM 1129, MAIL ROUTE 111G
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City | LOS ANGELES
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State | CA
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Zip | 90073
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Country | US
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Telephone | 310-478-3711
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Fax |
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Provider Business Mailing Address
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Address Line | 2510 JALMIA DR
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City | LOS ANGELES
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State | CA
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Zip | 90046-1716
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Country | US
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Telephone | 323-216-0006
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | G071885
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License Number State | CA
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