Provider Demographics
NPI:1124107511
Name:JAKOBSEN, JOELLE (MD)
Entity type:Individual
Prefix:
First Name:JOELLE
Middle Name:
Last Name:JAKOBSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6555 COYLE AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0302
Practice Address - Country:US
Practice Address - Phone:916-536-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63992208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA099094OtherHEALTH NET
CA5594834OtherFIRST HEALTH
CA00A63920OtherBLUE SHIELD
CA90145495OtherPACIFICARE
CAA63992OtherBLUE CROSS
CA000810659536OtherPHCS
CA1711526OtherGREAT WEST
CAMCMG384000OtherWESTERN HEALTH ADVANTAGE
CA248468OtherINTERPLAN
CA7931705OtherAETNA
CA00A639920Medicaid
CA3092075OtherCIGNA
CAMCMG384000OtherWESTERN HEALTH ADVANTAGE
CA00A639921Medicare ID - Type Unspecified