Provider Demographics
NPI:1689685885
Name:JACOBS, MEGAN S (MD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:S
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 W ROSECRANS AVE STE 22
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90222-3856
Mailing Address - Country:US
Mailing Address - Phone:424-529-6755
Mailing Address - Fax:424-338-8984
Practice Address - Street 1:12021 WILMINGTON AVE STE 1000
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-3019
Practice Address - Country:US
Practice Address - Phone:424-529-6755
Practice Address - Fax:424-338-8984
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83537207RE0101X
IL036109362207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
I34803Medicare UPIN