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General NPI Number Information
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NPI Number | 1831284249
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Entity Type | Individual
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Provider Name | MICHAEL BRIAN JACOBSON MD
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 02/01/2011
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Provider Practice Location Address
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Address Line | 250 E CHASE AVE SUITE 108
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City | EL CAJON
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State | CA
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Zip | 92020-6305
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Country | US
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Telephone | 619-442-2560
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Fax | 619-442-7836
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Provider Business Mailing Address
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Address Line | 250 E CHASE AVE SUITE 108
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City | EL CAJON
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State | CA
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Zip | 92020-6305
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Country | US
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Telephone | 619-442-2560
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Fax | 619-442-7836
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A88422
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License Number State | CA
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