Provider Demographics
NPI:1508559584
Name:JACOBSON, MARIVEL
Entity Type:Individual
Prefix:
First Name:MARIVEL
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2061 BUTTERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-2719
Mailing Address - Country:US
Mailing Address - Phone:916-397-5680
Mailing Address - Fax:916-966-9370
Practice Address - Street 1:2061 BUTTERFIELD LN
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-2719
Practice Address - Country:US
Practice Address - Phone:916-397-5680
Practice Address - Fax:916-966-9370
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315001404310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility