Individual
BRIAN JACOBO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
301 VICTORIA ST, COSTA MESA, CA 92627-1995
(949) 642-2734
Mailing address
10308 NIGHTINGALE AVE, FOUNTAIN VALLEY, CA 92708-7418
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
ASW84258
CA
Other
Enumeration date
02/12/2020
Last updated
03/12/2020
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