Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | G45704 | CA |
Y | 111NI0900X | Internist | G45704 | CA |
N | 207RA0401X | Internist - Addiction Medicine | G45704 | CA |
NPI | 1750455259 |
---|---|
Provider Name | Steven Jeffrey Jacobs |
First Address | Beverly Hills, CA 90211-1840 |
Second Address | Beverly Hills, CA 90211-1840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 18/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A92594 | (02) | CA |
G-457040 | (05) | CA |