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General NPI Number Information
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NPI Number | 1750277067
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Entity Type | Organization
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Legal Business Name | JACOB HATTENBACH DO INC
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Dates
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Enumeration Date | 06/13/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 2021 SANTA MONICA BLVD STE 200E
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City | SANTA MONICA
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State | CA
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Zip | 90404-2136
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Country | US
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Telephone | 323-709-3657
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Fax |
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Provider Business Mailing Address
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Address Line | 12021 WILSHIRE BLVD # 144
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City | LOS ANGELES
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State | CA
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Zip | 90025-1206
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JACOB HATTENBACH
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Credential | DO
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Telephone | 323-709-3657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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