MEDICARE: MARINA JACOBSON P.A.-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
1	363AM0700X	Medical Physician Assistant	PA01836	TX

General Provider Information

NPI Number	:	1114044120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARINA JACOBSON P.A.-C

Provider Business Mailing Address
First Line	:	PO BOX 4449
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78502-4449
Country	:	US
Telephone Number	:	956-362-2171
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 S 5TH ST STE 130
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78503-2915
Country	:	US
Telephone Number	:	956-687-7863
Fax Number	:	956-687-6405

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	01/19/2017

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