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NPI Code Detail

MEDICARE: JEENA JACOB APRN

MEDICARE: JEENA JACOB APRN
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
1363LA2200XAdult Health Nurse Practitioner95016908CA

General Provider Information

NPI Number : 1316522253
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEENA JACOB APRN
Provider Business Mailing Address
First Line : 3861 SEPULVEDA BLVD
Second Line :
City : CULVER CITY
State : CA
Zip : 90230-4605
Country : US
Telephone Number : 310-450-2191
Fax Number :
Provider Business Practice Location Address
First Line : 3861 SEPULVEDA BLVD
Second Line :
City : CULVER CITY
State : CA
Zip : 90230-4605
Country : US
Telephone Number : 310-450-2191
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2021
Last Update Date : 05/27/2026

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