Provider Demographics
NPI:1720346604
Name:JACOBS, SANDRA E (MA)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:E
Last Name:JACOBS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3145 MORNING WAY
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1908
Mailing Address - Country:US
Mailing Address - Phone:858-657-0021
Mailing Address - Fax:
Practice Address - Street 1:3145 MORNING WAY
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1908
Practice Address - Country:US
Practice Address - Phone:858-657-0021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 31067106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist