MEDICARE: DR. JACOB MANJOORAN MD

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	2084P0800X	Psychiatry Physician	11276	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	CC7754	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1508863374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB MANJOORAN MD

Provider Business Mailing Address
First Line	:	8475 S EASTERN AVE SUITE 202
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89123
Country	:	US
Telephone Number	:	775-900-8475
Fax Number	:

Provider Business Practice Location Address
First Line	:	8475 S EASTERN AVE STE 202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2863
Country	:	US
Telephone Number	:	775-900-8475
Fax Number	:

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	04/14/2026

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