Individual
MS. KIYUNDA RENEE NICOLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8019 COMPTON AVE, LOS ANGELES, CA 90001
(323) 586-7333
Mailing address
8019 COMPTON AVE, LOS ANGELES, CA 90001-3409
(323) 586-7333
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
175T00000X
Peer Specialist
Primary
—
CA
225400000X
Rehabilitation Practitioner
—
—
373H00000X
Day Training/Habilitation Specialist
—
—
Other
Enumeration date
10/08/2015
Last updated
08/06/2025
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