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General NPI Number Information
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NPI Number | 1871681809
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Entity Type | Individual
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Provider Name | LEE A. JACOBS D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 12/24/2009
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Provider Practice Location Address
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Address Line | 591 MCCRAY ST STE. 101
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City | HOLLISTER
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State | CA
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Zip | 95023-2224
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Country | US
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Telephone | 831-634-4444
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Fax | 831-634-4440
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Provider Business Mailing Address
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Address Line | 4 ROSSI CIR SUITE 141
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City | SALINAS
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State | CA
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Zip | 93907-2362
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Country | US
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Telephone | 831-757-4444
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Fax | 831-757-4419
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2OA5950
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License Number State | CA
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