Active NPI
Sandra Lee Jacobs, MFT
- Marriage & Family Therapist
- Corona, CA
National Provider Identifier
1639375207
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFT21524
- Practice address
- 2055 Kellogg Ave
Corona, CA 92879-3111 - Phone
- (951) 898-7153
- Fax
- (951) 898-7178
- NPI assigned
- Jun 21, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFT21524 | CA | Primary |
Addresses
Primary practice location
2055 Kellogg Ave
Corona, CA 92879-3111
Mailing address
2055 Kellogg Ave
Corona, CA 92879-3111
Phone (951) 898-7153
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFT21524 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639375207",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2055 KELLOGG AVE",
"city": "CORONA",
"state": "CA",
"postal_code": "928793111",
"telephone_number": "951-898-7153",
"fax_number": "951-898-7178"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2055 KELLOGG AVE",
"city": "CORONA",
"state": "CA",
"postal_code": "928793111",
"telephone_number": "951-898-7153",
"fax_number": "951-898-7178"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBS",
"first_name": "SANDRA",
"middle_name": "LEE",
"name_prefix": "Ms.",
"credential": "MFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFT21524",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.