Provider Demographics
NPI:1649480070
Name:JACOBSON, PAMELA JEAN (LAC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N TUSTIN AVE
Mailing Address - Street 2:SUITE 380
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3813
Mailing Address - Country:US
Mailing Address - Phone:714-730-2233
Mailing Address - Fax:714-730-2768
Practice Address - Street 1:400 N TUSTIN AVE
Practice Address - Street 2:SUITE 380
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3813
Practice Address - Country:US
Practice Address - Phone:714-730-2233
Practice Address - Fax:714-730-2768
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10904171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist