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General NPI Number Information
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NPI Number | 1659465607
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Entity Type | Individual
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Provider Name | JULIENNE RAQUEL JACOBSON MD
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 4650 W SUNSET BLVD MS# 82
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City | LOS ANGELES
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State | CA
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Zip | 90027-6062
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Country | US
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Telephone | 323-669-2471
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Fax | 323-667-2019
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Provider Business Mailing Address
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Address Line | 3250 WILSHIRE BLVD STE 1101
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City | LOS ANGELES
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State | CA
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Zip | 90010-1513
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Country | US
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Telephone | 323-361-2336
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | A68305
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License Number State | CA
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