1659492635 NPI number — DR. CLAIRE JACOBS

Table of content: (NPI 1659492635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659492635 NPI number — DR. CLAIRE JACOBS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. CLAIRE JACOBS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659492635
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14607 SAN PEDRO,
Provider Second Line Business Mailing Address:
SUITE 295
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78232-4325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-403-2050
Provider Business Mailing Address Fax Number:
210-403-9890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14607 SAN PEDRO
Provider Second Line Business Practice Location Address:
SUITE 295
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78232-4325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-403-2050
Provider Business Practice Location Address Fax Number:
210-403-9890
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OSTROM
Authorized Official First Name:
MEGAN
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
210-403-2050

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  23850 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC2200X , with the licence number: 23850 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 033967301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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