Individual
ANGELIQUE ALLYSSA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2122 S EL CAMINO REAL STE 201, OCEANSIDE, CA 92054-6210
(760) 290-8170
(760) 439-0019
Mailing address
2122 S EL CAMINO REAL STE 201, OCEANSIDE, CA 92054-6210
(760) 290-8170
(760) 439-0019
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
01/11/2022
Last updated
01/11/2022
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