MEDICARE: DR. CHRISTINA N JACOB M.D.

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	207R00000X	Internal Medicine Physician	A64955	CA

General Provider Information

NPI Number	:	1497758957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINA N JACOB M.D.

Provider Business Mailing Address
First Line	:	PO BOX 7629
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91359-7629
Country	:	US
Telephone Number	:	805-373-5864
Fax Number	:	805-374-2439

Provider Business Practice Location Address
First Line	:	2230 LYNN RD
Second Line	:	STE 230
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-1984
Country	:	US
Telephone Number	:	805-373-5864
Fax Number	:	805-374-2439

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/08/2007

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