# E C AMERICA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Carol Jackson, M.D.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326285180
- **Authorized official:** CAROL JACKSON M.D. (DIRECTOR)
- **Authorized official phone:** (949) 651-3415

## Contact information

- **Practice address:** 361 HOSPITAL RD, SUITE 325, NEWPORT BEACH, CA 92663-3522
- **Practice address phone:** (949) 651-3415
- **Mailing address:** 1835 NEWPORT BLVD STE A109, \#384, COSTA MESA, CA 92627-5007
- **Mailing address phone:** (949) 651-3415

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | D3824 | CA | Yes |

## Other

- **Enumeration date:** 01/15/2009
- **Last updated:** 10/18/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | G50085 | MEDICARE PTAN | CA |