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NPI Code Detail

MEDICARE: RYAN JACOBS PA-C

MEDICARE: RYAN JACOBS PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant52840CA

General Provider Information

NPI Number : 1023483591
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN JACOBS PA-C
Provider Business Mailing Address
First Line : 31581 CANYON ESTATES DR
Second Line :
City : LAKE ELSINORE
State : CA
Zip : 92532-0424
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 31581 CANYON ESTATES DR
Second Line :
City : LAKE ELSINORE
State : CA
Zip : 92532-0424
Country : US
Telephone Number : 951-244-3500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2015
Last Update Date : 12/03/2021

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Directions to “ RYAN JACOBS PA-C” Practice Location

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