Provider Demographics
NPI:1972605988
Name:JAKUBOWICZ, ISAAC ENRIQUE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:ENRIQUE
Last Name:JAKUBOWICZ
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25287
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-0287
Mailing Address - Country:US
Mailing Address - Phone:310-212-7706
Mailing Address - Fax:310-783-0104
Practice Address - Street 1:1400 COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-2321
Practice Address - Country:US
Practice Address - Phone:310-212-7706
Practice Address - Fax:310-783-0104
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33639207PP0204X, 208000000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F33347Medicare UPIN