Provider Demographics
NPI:1780950857
Name:BRENDA P. JACOBS, M.D., INC.
Entity type:Organization
Organization Name:BRENDA P. JACOBS, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:PENNY
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-595-7889
Mailing Address - Street 1:3550 LINDEN AVE
Mailing Address - Street 2:#1
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4577
Mailing Address - Country:US
Mailing Address - Phone:562-595-7889
Mailing Address - Fax:562-595-1335
Practice Address - Street 1:3550 LINDEN AVE
Practice Address - Street 2:#1
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4577
Practice Address - Country:US
Practice Address - Phone:562-595-7889
Practice Address - Fax:562-595-1335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45847207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA15781Medicare UPIN