Basic Information
| Provider Information | |||||||||
| NPI: | 1801997051 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JACOBSEN | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D. O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 310 COLON AVE | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941272106 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2850 TELEGRAPH AVE | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947051192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108839883 | ||||||||
| FaxNumber: | 5108430804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 07/10/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | 1013 | HI | N | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 207Q00000X | 20A9734 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.