Provider Demographics
NPI:1558615120
Name:JACOB, DHINU ELSA
Entity Type:Individual
Prefix:MRS
First Name:DHINU
Middle Name:ELSA
Last Name:JACOB
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 1:20300 VANOWEN ST APT 34
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-4357
Mailing Address - Country:US
Mailing Address - Phone:818-456-7019
Mailing Address - Fax:
Practice Address - Street 1:8510 BALBOA BLVD STE 150
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-5810
Practice Address - Country:US
Practice Address - Phone:818-637-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA560101835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist