Active NPI
Devonna Jacobs
- Counselor
- San Leandro, CA
National Provider Identifier
1003246323
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 3081 Teagarden St
San Leandro, CA 94577-5720 - Phone
- (510) 347-4620
- NPI assigned
- Nov 22, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | |||
| Counselor | 101Y00000X | Primary |
Addresses
Primary practice location
3081 Teagarden St
San Leandro, CA 94577-5720
Mailing address
3081 Teagarden St
San Leandro, CA 94577-5720
Phone (510) 347-4620
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06902 | MD | MD | Physical Medicine & Rehabilitation Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1385078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568160000000",
"number": "1003246323",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3081 TEAGARDEN ST",
"city": "SAN LEANDRO",
"state": "CA",
"postal_code": "945775720",
"telephone_number": "510-347-4620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3081 TEAGARDEN ST",
"city": "SAN LEANDRO",
"state": "CA",
"postal_code": "945775720",
"telephone_number": "510-347-4620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "DEVONNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-11-22",
"last_updated": "2019-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Leandro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.