Provider Demographics
NPI:1821146135
Name:JACOB, LAUREN A (LAC)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:A
Last Name:JACOB
Suffix:
Gender:F
Credentials:LAC
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Mailing Address - Street 1:9949 YOUNG DR
Mailing Address - Street 2:#103
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3630
Mailing Address - Country:US
Mailing Address - Phone:310-551-2808
Mailing Address - Fax:310-551-2808
Practice Address - Street 1:1137 2ND ST
Practice Address - Street 2:SUITE 205
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5011
Practice Address - Country:US
Practice Address - Phone:310-488-9571
Practice Address - Fax:310-488-9571
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2011-04-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAAC 3047171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist