Provider Demographics
NPI:1134335706
Name:LAURENCE L. JACOBS, M.D., A.P.C.
Entity type:Organization
Organization Name:LAURENCE L. JACOBS, M.D., A.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:LIBERTY
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-642-6320
Mailing Address - Street 1:320 SUPERIOR AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2716
Mailing Address - Country:US
Mailing Address - Phone:949-642-6320
Mailing Address - Fax:
Practice Address - Street 1:320 SUPERIOR AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2716
Practice Address - Country:US
Practice Address - Phone:949-642-6320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A131180Medicaid
CAA13118Medicare ID - Type Unspecified
CA00A131180Medicaid
A19333Medicare UPIN