Provider Demographics
NPI:1083682371
Name:JACOBS, BRENDA PENNY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:PENNY
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:3550 LINDEN AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4577
Mailing Address - Country:US
Mailing Address - Phone:562-595-7889
Mailing Address - Fax:562-595-1335
Practice Address - Street 1:3550 LINDEN AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4577
Practice Address - Country:US
Practice Address - Phone:562-595-7889
Practice Address - Fax:562-595-1335
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2011-10-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG45847207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA15781Medicare UPIN