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General NPI Number Information
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NPI Number | 1477405892
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Entity Type | Individual
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Provider Name | DEMETRIUS JACOBS
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Gender | Male
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Dates
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Enumeration Date | 02/10/2026
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 584 KENTUCKY AVE
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City | WOODLAND
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State | CA
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Zip | 95695-2779
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Country | US
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Telephone | 530-661-3213
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Fax |
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Provider Business Mailing Address
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Address Line | 7444 GARDEN MEADOW LN
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City | CITRUS HEIGHTS
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State | CA
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Zip | 95610-2984
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Country | US
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Telephone | 916-478-1353
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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 | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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