Provider Demographics
NPI:1033733944
Name:JOSHUA JACOBSON MD, INC
Entity Type:Organization
Organization Name:JOSHUA JACOBSON MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:YOUSHA
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-282-6810
Mailing Address - Street 1:30200 AGOURA RD STE 150
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-5427
Mailing Address - Country:US
Mailing Address - Phone:929-322-4182
Mailing Address - Fax:330-481-5023
Practice Address - Street 1:30200 AGOURA RD STE 150
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-5427
Practice Address - Country:US
Practice Address - Phone:929-322-4182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty