Provider Demographics
NPI:1811100134
Name:JACOBS, PHILIPPA (NP)
Entity type:Individual
Prefix:MRS
First Name:PHILIPPA
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2522 31ST ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3011
Mailing Address - Country:US
Mailing Address - Phone:310-450-0328
Mailing Address - Fax:
Practice Address - Street 1:14623 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1581
Practice Address - Country:US
Practice Address - Phone:213-284-3121
Practice Address - Fax:213-284-3369
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA118699363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA118699OtherR.N.P. LICENSE