Randy Jacobs Dermatology Inc.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

A049395 Issued in CA

Legal business name

RANDY JACOBS DERMATOLOGY INC.

Practice address

27640 Encanto Dr
# B
Sun City, CA 92586-3304

Phone

(951) 672-7673

Fax

(951) 672-1197

NPI assigned

Sep 20, 2006

Last updated

Mar 12, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Tammy S Bolon

Title

Office Manager

Phone

(951) 672-7673

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Donna Hastert, P.A.-C

  • Physician Assistant
  • Sun City, CA
  • NPI 1932204351
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205280000000",
    "number": "1699872630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23905 CLINTON KEITH RD",
            "address_2": "114",
            "city": "WILDOMAR",
            "state": "CA",
            "postal_code": "925957899",
            "telephone_number": "951-672-7673",
            "fax_number": "951-672-1197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27640 ENCANTO DR",
            "address_2": "# B",
            "city": "SUN CITY",
            "state": "CA",
            "postal_code": "925863304",
            "telephone_number": "951-672-7673",
            "fax_number": "951-672-1197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDY JACOBS DERMATOLOGY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2008-03-12",
        "status": "A",
        "authorized_official_last_name": "BOLON",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "951-672-7673",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A049395",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Sun City, CA
• Providers in Sun City, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.