MEDICARE: DARREN E JACOBS SR.

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	101YS0200X	School Counselor	74303	NV
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1740446020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARREN E JACOBS SR.

Provider Business Mailing Address
First Line	:	4588 N RANCHO DR
Second Line	:	12
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3426
Country	:	US
Telephone Number	:	702-396-3464
Fax Number	:	702-396-6164

Provider Business Practice Location Address
First Line	:	315 S 7TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-5801
Country	:	US
Telephone Number	:	702-799-7800
Fax Number	:	702-799-1600

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

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	11/01/2010

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Directions to “ DARREN E JACOBS SR. ” Practice Location

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