Individual
DR. LOURDES R JACOBO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2120 CENTERPOINTE WEST DR, PRESCOTT, AZ 86301-8487
(928) 778-4581
(928) 776-1872
Mailing address
16950 N 49TH WAY, SCOTTSDALE, AZ 85254-1082
(623) 238-4284
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
23974
NJ
208000000X
Pediatrics Physician
Primary
40096
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40096
LICENSE
AZ
05
—
401708
—
AZ
Enumeration date
01/26/2007
Last updated
08/25/2016
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