Active NPI
Alissa Marie Jacobo, ACSW
- Clinical Social Worker
- Costa Mesa, CA
National Provider Identifier
1699499855
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 110674
- Practice address
- 301 Victoria St
Costa Mesa, CA 92627-1995 - Phone
- (949) 642-2734
- NPI assigned
- Sep 30, 2022
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 110674 | CA | Primary |
Addresses
Primary practice location
301 Victoria St
Costa Mesa, CA 92627-1995
Mailing address
301 Victoria St
Costa Mesa, CA 92627-1995
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 |
|---|---|---|---|
| 110674 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1665532800000",
"number": "1699499855",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 VICTORIA ST",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926271995"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 VICTORIA ST",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926271995",
"telephone_number": "949-642-2734"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOBO",
"first_name": "ALISSA",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "ACSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-30",
"last_updated": "2022-10-12",
"certification_date": "2022-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "110674",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Costa Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.