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General NPI Number Information
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NPI Number | 1467047134
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Entity Type | Individual
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Provider Name | JANAY JACOBS
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Gender | Female
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Dates
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Enumeration Date | 03/04/2021
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Last Update Date | 03/04/2021
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Provider Practice Location Address
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Address Line | 19782 MACARTHUR BLVD STE 310
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City | IRVINE
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State | CA
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Zip | 92612-2417
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Country | US
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Telephone | 949-929-9248
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Fax |
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Provider Business Mailing Address
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Address Line | 802 N WHITE TAIL CT
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City | WICHITA
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State | KS
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Zip | 67206-4174
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Country | US
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Telephone | 707-572-0236
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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 | 207ZP0213X
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Taxonomy Name | Pediatric Pathology Physician
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License Number | 5826
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License Number State | CA
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