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Contact Information

RANDOLPH J JACOBS, MD
23905 CLINTON KEITH RD STE 114
WILDOMAR, CA92595-7899
 Phone: 951-672-7673
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dermatology

207N00000X 07 Physician/Dermatology
 

Clinical & Laboratory Dermatological Immunology

207NI0002X 07 Physician/Dermatology
 

Dermatopathology

207ND0900X 07 Physician/Dermatology
 

MOHS-Micrographic Surgery

207ND0101X 07 Physician/Dermatology
 

Pediatric Dermatology

207NP0225X 07 Physician/Dermatology
Indicates primary specialty

NPI Profile & details for RANDOLPH J JACOBS · (Male)

NPI Number 1417975905
Status Active
Credentials MD
Entity Individual
Enumeration date 07/17/2006
Last updated 03/12/2008 - About 18 years ago
Sole proprietor 1 Yes
Identifiers
  • CA License # G61654
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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