Provider Demographics
NPI:1891910931
Name:JACOBSON, SHARON DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:DIANE
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1823 SAWTELLE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5532
Mailing Address - Country:US
Mailing Address - Phone:310-479-6774
Mailing Address - Fax:310-477-0661
Practice Address - Street 1:1823 SAWTELLE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5532
Practice Address - Country:US
Practice Address - Phone:310-479-6774
Practice Address - Fax:310-477-0661
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA224432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry