Provider Demographics
NPI:1063026144
Name:COMEAUX, JACOB (LGCG)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:COMEAUX
Suffix:
Gender:M
Credentials:LGCG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 BIGGY ST # 2517R
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-1006
Mailing Address - Country:US
Mailing Address - Phone:323-865-0933
Mailing Address - Fax:323-865-0933
Practice Address - Street 1:1450 BIGGY ST # 2517R
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1006
Practice Address - Country:US
Practice Address - Phone:323-865-0911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC001244170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS