Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | 235642 | CA |
N | 363LW0102X | Nurse Practitioner - Women's Health | NP95000656 | CA |
NPI | 1073923074 |
---|---|
Provider Name | Christina Jacobson |
First Address | San Diego, CA 92105-1608 |
Second Address | San Diego, CA 92105-1608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2014 |
Last Update Date | 07/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
235642 | 235642 (01) | CA |