=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720678501
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA ELAINE JACOBSON NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2021
-----------------------------------------------------
Last Update Date | 04/18/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 S DOHENY DR
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90048-3704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-640-5117
-----------------------------------------------------
Fax | 424-389-7037
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8314 BEVERLY BLVD STE 202
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90048-2666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 424-271-0010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 95031340
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 95233156
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------