Individual
MR. EDDIE JACOBO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2609 W BEVERLY BLVD STE 3, MONTEBELLO, CA 90640-2300
(909) 342-8951
Mailing address
2609 W BEVERLY BLVD STE 3, MONTEBELLO, CA 90640-2300
(909) 342-8951
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
C51396
MD
1744P3200X
Prosthetics Case Management
C51396
MD
332BC3200X
Customized Equipment (DME)
Primary
C51396
MD
Other
Enumeration date
06/08/2015
Last updated
06/08/2015
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