| Doctor Name: | RYAN JACOBS |
| NPI Number: | 1023483591 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | 52840 |
| Business Practice Address: | 31581 Canyon Estates Dr Lake Elsinore, CA - 925320424 |
| Business Phone Number: | 9512443500 |
| Business Fax Number: | |
| Mailing Address: | 31581 Canyon Estates Dr, LAKE ELSINORE |
| State: | CA |
| Postal Code: | 925320424 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 12/08/2015 |
| NPI Last Update Date: | 03/11/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 52840 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |