Provider Demographics
NPI:1043296254
Name:JACOBS, HAROLD SIDNEY (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:SIDNEY
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HAROLD
Other - Middle Name:S
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6530 REFLECTION DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-5118
Mailing Address - Country:US
Mailing Address - Phone:719-406-2916
Mailing Address - Fax:760-291-0301
Practice Address - Street 1:815 E PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3424
Practice Address - Country:US
Practice Address - Phone:760-466-7020
Practice Address - Fax:760-291-0301
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC-29286171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor