| Doctor Name: | DR. RANDOLPH J JACOBS |
| NPI Number: | 1417975905 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | G61654 |
| Business Practice Address: | 23905 Clinton Keith Rd Ste 114 Wildomar, CA - 925957899 |
| Business Phone Number: | 9516727673 |
| Business Fax Number: | |
| Mailing Address: | 23905 Clinton Keith Rd Ste 114, WILDOMAR |
| State: | CA |
| Postal Code: | 925957899 |
| Phone Number: | 9516727673 |
| Fax Number: | 9516721197 |
| NPI Enumeration Date: | 07/17/2006 |
| NPI Last Update Date: | 03/12/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207NI0002X |
| License Number: | G61654 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Dermatology |
| Taxonomy Specialization: | Clinical & Laboratory Dermatological Immunology |
| Taxonomy Definition: | A dermatologist who utilizes various specialized laboratory procedures to diagnose disorders characterized by defective responses of the body's immune system. Immunodermatologists also may provide consultation in the management of these disorders and administer specialized forms of therapy for these diseases. |