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General NPI Number Information
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NPI Number | 1558615120
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Entity Type | Individual
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Provider Name | MRS. DHINU ELSA JACOB
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Gender | Female
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 11/05/2012
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Provider Practice Location Address
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Address Line | 8510 BALBOA BLVD STE 150
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City | NORTHRIDGE
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State | CA
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Zip | 91325-5810
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Country | US
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Telephone | 818-637-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 20300 VANOWEN ST APT 34
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City | WINNETKA
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State | CA
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Zip | 91306-4357
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Country | US
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Telephone | 818-456-7019
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 56010
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License Number State | CA
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