Poulose, Jacob

Poulose, Jacob is an individual health care provider with primary practice located at 8349 Reseda Blvd Ste G , Northridge CA 91324-5914. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Nephrology. Allopathic & Osteopathic Physicians / Nephrology is his primary health care specialty. Poulose, Jacob can be contacted via phone (818) 886-5827.

Contact Information

Primary practice address
8349 Reseda Blvd Ste G Northridge CA 91324-5914
Phone: (818) 886-5827
Fax: (818) 775-9351
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X A113557 California
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X A113557 California

Profile Details

NPI number 1578723508
LBN Legal business name Poulose, Jacob
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 12th, 2008
Last updated Jan 11th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578723508 NPPES
California MEDICAID 00A1135570

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