1629461314 NPI number — DR. JOSEPH DANIEL JACOBS PHD, BCBA-D

Table of content: DR. JOSEPH DANIEL JACOBS PHD, BCBA-D (NPI 1629461314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629461314 NPI number — DR. JOSEPH DANIEL JACOBS PHD, BCBA-D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JACOBS
Provider First Name:
JOSEPH
Provider Middle Name:
DANIEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, BCBA-D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629461314
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16350 VENTURA BLVD STE D147
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENCINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91436-5300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-957-5126
Provider Business Mailing Address Fax Number:
818-654-6536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12304 SANTA MONICA BLVD STE 315
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90025-2551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-957-5126
Provider Business Practice Location Address Fax Number:
323-272-4076
Provider Enumeration Date:
03/05/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: PSY33549 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: PSY33549 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GR8889095 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".