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General NPI Number Information
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NPI Number | 1952443673
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Entity Type | Individual
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Provider Name | RICHARD SAMUEL JACOBSON M,D,
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Gender | Male
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/21/2012
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Provider Practice Location Address
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Address Line | 10515 BALBOA BL. SUITE 250
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City | GRANADA HILLS
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State | CA
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Zip | 91344
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Country | US
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Telephone | 818-831-2343
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Fax |
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Provider Business Mailing Address
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Address Line | 11591 YARMOUTH AVE
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City | GRANADA HILLS
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State | CA
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Zip | 91344-2102
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Country | US
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Telephone | 818-366-7700
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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 | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number | G15588
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2080P0008X
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Taxonomy Name | Pediatric Neurodevelopmental Disabilities Physician
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License Number | G15588
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G15588
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License Number State | CA
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