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RANDY JACOBS DERMATOLOGY INC. NPI 1699872630


NPI Information

NPI: 1699872630
Provider Name: RANDY JACOBS DERMATOLOGY INC.
Classification: Dermatology - 207N00000X
Entity Type: Organization

CLIA Number: 05D0713339

Address:
27640 ENCANTO DR
# B
SUN CITY, CA
ZIP 92586
Phone: (951) 672-7673
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RANDY JACOBS DERMATOLOGY INC. is a dermatology in Sun City, CA. The provider is a dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. RANDY JACOBS DERMATOLOGY INC. NPI is 1699872630. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

27640 ENCANTO DR
# B
SUN CITY, CA
ZIP 92586-304
Phone: (951) 672-7673
Fax: (951) 672-1197

The provider's authorized official is Tammy S Bolon .
The authorized official title is Office Manager and has the following contact phone number (951) 672-7673.

The CLIA number assigned to this NPI record is 05D0713339 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 9/20/2006 and was last updated on 3/12/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207N00000XDermatologyA049395CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1E25046MEDICARE UPINCALIFORNIA
200G616540MEDICARE PINCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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