Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. RANDOLPH J JACOBS, M.D.
Active Sole ProprietorDR. RANDOLPH J JACOBS, M.D. is a Dermatology healthcare provider located in WILDOMAR, California. NPI 1417975905 is currently active in the NPPES registry. Verify at CMS.
Dermatology · WILDOMAR, CA
Registration Details
- NPI Number
- 1417975905
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jul 17, 2006 (19.893320653219 yrs)
- Last Updated
- Mar 12, 2008
- Licenses
-
G61654 (CA)G61654 (CA)G61654 (CA)G61654 (CA)G61654 (CA)
- Sole Proprietor
- Yes
Practice Information
- Address
-
23905 CLINTON KEITH RD STE 114WILDOMAR, CA, 925957899Browse CA providers · Browse ZIP 92595
- Phone
- 9516727673
- Primary Specialty
-
Dermatology
207N00000X
- Additional Specialty
- Clinical & Laboratory Dermatological Immunology
- Additional Specialty
- Dermatopathology
- Additional Specialty
- Obesity Medicine
- Additional Specialty
- 207NP0225X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.