Provider Demographics
NPI:1710109509
Name:JACOBI, JOSHUA A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:A
Last Name:JACOBI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S FAIR OAKS AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2562
Mailing Address - Country:US
Mailing Address - Phone:626-716-9206
Mailing Address - Fax:626-709-3568
Practice Address - Street 1:301 S FAIR OAKS AVE STE 404
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2562
Practice Address - Country:US
Practice Address - Phone:626-716-9206
Practice Address - Fax:626-709-3568
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3348207RC0000X, 207RI0011X
CAC55905207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158395702Medicaid
TX158395702Medicaid
TX8L8788Medicare PIN