Individual
BRENT JACOBSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
36485 INLAND VALLEY DR, WILDOMAR, CA 92595-9681
(909) 677-9773
Mailing address
2100 POWELL ST, SUITE 900, EMERYVILLE, CA 94608-1826
(510) 350-2600
(510) 879-9100
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
20A8142
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00AX814200
—
CA
Enumeration date
08/20/2006
Last updated
11/06/2007
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