Dr. Randolph J Jacobs
Dermatologist Dermatopathologist Pediatric Dermatologist MOHS-Micrographic Surgeon
23905 Clinton Keith Rd Ste 114
Wildomar
, California 92595-7899
Dr. Randolph J Jacobs
Dermatologist Dermatopathologist Pediatric Dermatologist MOHS-Micrographic Surgeon
23905 Clinton Keith Rd Ste 114
Wildomar
, California 92595-7899
(951) 672-1197
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About
Features
Specialties
- Dermatologist
- MOHS-Micrographic Surgeon
- Dermatopathologist
- Pediatric Dermatologist
Languages spoken
- English
Location
First Address
- Dr. Randolph J Jacobs
- 23905 Clinton Keith Rd Ste 114
- Wildomar, CA
- Zip : 92595-7899
- Fax : (951) 672-1197
- Phone : (951) 672-7673
Second Address
- Dr. Randolph J Jacobs
- 23905 Clinton Keith Rd Ste 114
- Wildomar, CA
- Zip : 92595-7899
- Phone : (951) 672-7673
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FAQs
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Is Dr. Randolph J Jacobs a sole practitioner?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207N00000X | Dermatologist | G61654 | CA |
| N | 207ND0101X | MOHS-Micrographic Surgeon | G61654 | CA |
| N | 207ND0900X | Dermatopathologist | G61654 | CA |
| N | 207NP0225X | Pediatric Dermatologist | G61654 | CA |
National Provider Identifier
| NPI | 1417975905 |
|---|---|
| Provider Name | Dr. Randolph J Jacobs |
| First Address | Wildomar, CA 92595-7899 |
| Second Address | Wildomar, CA 92595-7899 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 17/07/2006 |
| Last Update Date | 12/03/2008 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 25046 | (02) | CA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.