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General NPI Number Information
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NPI Number | 1972980076
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Entity Type | Individual
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Provider Name | RHEMA SUSAN JACOB D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/28/2015
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 1722 KELLER PKWY STE 124
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City | KELLER
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State | TX
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Zip | 76248-3749
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Country | US
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Telephone | 817-527-1554
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Fax | 949-404-8846
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Provider Business Mailing Address
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Address Line | 1722 KELLER PKWY STE 124
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City | KELLER
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State | TX
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Zip | 76248-3749
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Country | US
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Telephone | 817-527-1554
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Fax | 949-404-8846
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | R6211
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License Number State | TX
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