Basic Information
| Provider Information | |||||||||
| NPI: | 1073923074 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JACOBSON | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | |||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4060 FAIRMOUNT AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921051608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192801105 | ||||||||
| FaxNumber: | 6192808134 | ||||||||
| Practice Location | |||||||||
| Address1: | 4060 FAIRMOUNT AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921051608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192801105 | ||||||||
| FaxNumber: | 6192808134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2014 | ||||||||
| LastUpdateDate: | 09/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | NP95000656 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 367A00000X | NMW235642 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 176B00000X | 235642 | CA | N | Other Service Providers | Midwife |
ID Information
| ID | Type | State | Issuer | Description | 235642 | 01 | CA | 235642 | OTHER |