Organization
JACKSON MEDICAL ENTERPRISE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MALIA M JACKSON RODRIGUEZ M.D. (OWNER)
(239) 207-0948
Entity
Organization
Contact information
Practice address
4800 ASTON GARDENS WAY, MEDICAL DIRECTOR'S OFFICE, NAPLES, FL 34109-3501
(239) 330-1301
Mailing address
2263 CAMPESTRE TER, NAPLES, FL 34119-3358
(239) 207-0948
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
ME 104632
FL
310400000X
Assisted Living Facility
ME 104632
FL
314000000X
Skilled Nursing Facility
ME 104632
FL
Other
Enumeration date
05/04/2016
Last updated
05/04/2016
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