Provider Demographics
NPI:1063886869
Name:DAVIDSON, JACOB ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:ALEXANDER
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3835 N FREEWAY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1954
Mailing Address - Country:US
Mailing Address - Phone:916-576-7900
Mailing Address - Fax:213-784-5690
Practice Address - Street 1:16255 VENTURA BLVD STE 500
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2310
Practice Address - Country:US
Practice Address - Phone:855-427-2778
Practice Address - Fax:213-784-5690
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2023-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA1761982084P0800X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty