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Individual

JACE DOUGLAS JACOBSEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
6442 GLORIA DR, HUNTINGTON BEACH, CA 92647-4226
(805) 814-2463
Mailing address
6442 GLORIA DR, HUNTINGTON BEACH, CA 92647-4226
(805) 814-2463

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
832119
CA
367500000X
Certified Registered Nurse Anesthetist
Primary
95001352
CA

Other

Enumeration date
05/21/2020
Last updated
10/12/2023
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