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General NPI Number Information
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NPI Number | 1518947308
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Entity Type | Individual
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Provider Name | GEOFFREY SAMUEL JACOBY MD
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Gender | Male
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 162 1ST ST BLDG 1402
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City | PORT HUENEME
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State | CA
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Zip | 93043-4316
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Country | US
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Telephone | 805-982-6356
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Fax |
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Provider Business Mailing Address
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Address Line | 162 1ST ST BLDG 1402
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City | PORT HUENEME
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State | CA
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Zip | 93043-4316
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Country | US
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Telephone | 805-982-6356
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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 | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number | C53774
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C53774
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License Number State | CA
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