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General NPI Number Information
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NPI Number | 1366558470
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Entity Type | Organization
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Legal Business Name | WALTER E. JACOBSON, MD, INC.
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 18300 ROSCOE BLVD IFL TOWER, 4TH FLOOR
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City | NORTHRIDGE
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State | CA
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Zip | 91325-4105
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Country | US
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Telephone | 818-885-8500
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Fax | 818-865-2124
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Provider Business Mailing Address
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Address Line | 5699 KANAN RD #433
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City | AGOURA HILLS
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State | CA
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Zip | 91301-3358
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Country | US
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Telephone | 818-885-8500
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Fax | 818-865-2124
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WALTER ERIC JACOBSON
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Credential | MD
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Telephone | 818-885-8599
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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 | A61016
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License Number State | CA
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