Individual
DR. RANDOLPH J JACOBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
23905 CLINTON KEITH RD STE 114, WILDOMAR, CA 92595-7899
(951) 672-7673
Mailing address
23905 CLINTON KEITH RD STE 114, WILDOMAR, CA 92595-7899
(951) 672-7673
(951) 672-1197
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
G61654
CA
207ND0101X
MOHS-Micrographic Surgery Physician
G61654
CA
207ND0900X
Dermatopathology Physician
G61654
CA
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
G61654
CA
207NP0225X
Pediatric Dermatology Physician
G61654
CA
Other
Enumeration date
07/17/2006
Last updated
03/12/2008
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