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General NPI Number Information
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NPI Number | 1912626730
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Entity Type | Individual
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Provider Name | JACOB MATTHEW SCHOLL PA
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Gender | Male
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Dates
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Enumeration Date | 08/24/2022
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Last Update Date | 04/21/2023
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Provider Practice Location Address
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Address Line | 207 W LEGION RD
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City | BRAWLEY
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State | CA
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Zip | 92227-7780
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Country | US
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Telephone | 760-351-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 35995 MITCHELL RD APT 1402
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City | MURRIETA
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State | CA
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Zip | 92562-4412
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Country | US
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Telephone | 951-401-9106
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA62642
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License Number State | CA
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