| Shahram Jacobs M.d., Inc | |
|
16133 Ventura Blvd #340 / 370 Encino CA 91436-2403 | |
| (818) 981-1555 | |
| (818) 981-1510 |
| Full Name | Shahram Jacobs M.d., Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 16133 Ventura Blvd, Encino, California |
| Authorized Official Name and Position | Shahram Jacobs (PRESIDENT/ SECRETARY/ TREASURER) |
| Authorized Official Contact | 8189811555 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shahram Jacobs M.d., Inc 16133 Ventura Blvd #340 / 370 Encino CA 91436-2403 Ph: (818) 981-1555 | Shahram Jacobs M.d., Inc 16133 Ventura Blvd #340 / 370 Encino CA 91436-2403 Ph: (818) 981-1555 |
| NPI Number | 1952592958 |
|---|---|
| Provider Enumeration Date | 08/05/2007 |
| Last Update Date | 11/05/2008 |
| Medicare PECOS PAC ID | 9032283965 |
|---|---|
| Medicare Enrollment ID | O20080811000346 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952592958 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A89999 (California) | Primary |
| Provider Name | Shahram Jacobs |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659439040 PECOS PAC ID: 4880609247 Enrollment ID: I20060207000644 |
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