Provider Demographics
NPI:1447929997
Name:JACOBSON, RUTH (NP)
Entity type:Individual
Prefix:MS
First Name:RUTH
Middle Name:
Last Name:JACOBSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:RUTH
Other - Middle Name:
Other - Last Name:SHURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1622 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6549
Mailing Address - Country:US
Mailing Address - Phone:818-261-0474
Mailing Address - Fax:
Practice Address - Street 1:455 E COLUMBIA ST STE 201
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1607
Practice Address - Country:US
Practice Address - Phone:844-822-4646
Practice Address - Fax:562-216-6192
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018243363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily