Individual
JACOB POULOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD.
Contact information
Practice address
8349 RESEDA BLVD STE G, NORTHRIDGE, CA 91324-5914
(818) 886-5827
(818) 775-9351
Mailing address
8349 RESEDA BLVD STE G, NORTHRIDGE, CA 91324-5914
(818) 886-5828
(818) 775-9351
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A113557
CA
207RN0300X
Nephrology Physician
Primary
A113557
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A1135570
—
CA
Enumeration date
06/12/2008
Last updated
01/11/2022
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