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General NPI Number Information
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NPI Number | 1609272335
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Entity Type | Individual
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Provider Name | KAREN JACOBS PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/06/2014
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 955 CARRILLO DR STE 108
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City | LOS ANGELES
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State | CA
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Zip | 90048-5400
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Country | US
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Telephone | 323-651-4454
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Fax |
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Provider Business Mailing Address
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Address Line | 3201 CARDIFF AVE
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City | LOS ANGELES
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State | CA
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Zip | 90034-2811
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Country | US
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Telephone | 917-449-3478
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA-16502
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License Number State | CA
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