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General NPI Number Information
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NPI Number | 1639375207
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Entity Type | Individual
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Provider Name | SANDRA LEE JACOBS MFT
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Gender | Female
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2055 KELLOGG AVE
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City | CORONA
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State | CA
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Zip | 92879-3111
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Country | US
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Telephone | 951-898-7153
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Fax | 951-898-7178
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Provider Business Mailing Address
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Address Line | 2055 KELLOGG AVE
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City | CORONA
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State | CA
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Zip | 92879-3111
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Country | US
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Telephone | 951-898-7153
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Fax | 951-898-7178
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT21524
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License Number State | CA
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